Title First name
Surname
Email
Phone number
Postcode
Date of birth
Address
Mobile number
If you’re an existing member, please state your membership number
Unemployment or redundancy
Required evidence (include one of the following)
-
A letter on headed stationery from your company stating
redundancy notice and a P45 within the last 12 months.
- Jobseeker’s Allowance or an alternative.
- Bank statements for the last three months.
Low wages/semi-retired/career break
Required evidence
- A letter on headed stationery from your company stating
annual wage and wage slips for the last three months.
Ill-health for a 12-month minimum period
Required evidence
- A sickness/absence letter from a consultant, GP or your
employer.
Maternity/paternity/adoptive leave
Required evidence
- A
MAT B1 form and a letter on headed stationery from
your company stating maternity or paternity start and
end dates.
Retired (not working)
(please tick one box only)
with CPD without CPD
Required evidence
- A copy of your pension letter.
Reasons for concessionary application (please tick one box only). You must include the stated required evidence.
If you are joining as a new member, please include a membership application form.
Please sign this form and email to csc@iosh.com. Please make sure you’ve included the required evidence.
Signature
Date
Concessionary membership
application form
IOSH, The Grange, Highfield Drive, Wigston, Leicestershire, LE18 1NN, UK t +44 (0)116 257 3100 www.iosh.com
Institution of Occupational Safety and Health, Founded 1945, Incorporated by Royal Charter 2003, Registered charity 1096790
