STA - Endorsement Renewal

Contact Details

By completing this form, the person named below confirms that they have the authority to instigate renewal on behalf of the endorsed provider, and by doing so agrees that the renewal fee will be paid in full by the due date.

Organisation Name

First Name

Last Name

Direct line

Have the contact details specified last year changed?

YesNo

Please provide details so we can update our records.

Main Contact First Name

Main Contact Last Name

Main Contact Job Title

Main Contact Telephone

Main Contact Email

Finance Contact First Name

Finance Contact Last Name

Finance Contact Telephone

Finance Contact Email

Administrator Contact First Name

Administrator Contact Last Name

Administrator Contact Telephone

Administrator Contact Email

Terms and Payment

Where is your invoicing address:

UKRest of World

Are you VAT registered?

YesNo

VAT No:

Please provide evidence of your business status

Upload a letterhead paperProvide the registered Company Number

Please provide your registered company number.

Please upload a letterhead paper

The cost of your renewal is

The cost of your renewal including VAT is

Total to Pay

Please note if you have selected Dual Recognition the appropriate additional renewal fee will be added to the total.

PO number (if applicable)

Payment method

I confirm that the information I have provided in this renewal application is true and accurate as to provide inaccurate and untrue information may put the insurance of my graduates at risk and cause my endorsement to be invalid.

I have read and agree to the Contract Terms including the Code of Conduct & Practice (please click the link below to read and then agree to them here).

Contract Terms including the Code of Conduct and Practice.

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