Agency Nurses Umbrella online registration form
Agency Network Ltd t/a Agency Nurses Umbrella (ANU) is a Payroll company and not an employer. We liaise with your Employment business / Agency on your instructions to process your payment only. We are only able to process and pay you the hours and rates submitted to us by your Agency. Company registration no. 10837599, Registered office address: 27 Old Gloucester Street, London, WC1N 3AX
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Full name *
Date of birth *
Nationality *
Residential address *
Mobile no. *
Email address *
Gender *
Location *
Marital status
Position *
If other, please specify
How many agencies are you registered with? *
Name(s) of registered agency *
Contact email of agency Consultant *
Which of the below apply to you *
Do you have a P45 from previous employer
Preferred method of payment *
Bank details
**please do not provide business bank account details. This will need to be verified. Details provided are solely for payment of contractor fees as per contract terms and conditions
Bank name *
Account name *
Account number *
Sort Code *
Preferred mode of contact *
NI number. *
How did you hear about us? *
Do you consent to the processing of your information by ANU as per GDPR? *
Signature/initials *
Congratulations! Your registration is now complete. Thank you for your time taken to complete this form. For further inquiries, please call or WhatApp us on 07528069813. Alternatively, you can send an email to
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