Title First name
Date of birth
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
- 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
- A sickness/absence letter from a consultant, GP or your
MAT B1 form and a letter on headed stationery from
your company stating maternity or paternity start and
Retired (not working)
(please tick one box only)
with CPD without CPD
- 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 email@example.com. Please make sure you’ve included the required evidence.
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