I understand that the appointment is offered will be subject to the information given on this form being correct. I fully accept that I am eligible to work in the UK and I am applying for membership of London Healthcare Agency in the full knowledge and understanding that should London Healthcare Agency offer an introduction to a client and I accept such an introduction, any services which I provide are provided as self-employed person while asserting the role of London Healthcare Agency as that of an agent and not employer. In signing this disclaimer I acknowledge that neither London Healthcare Agency nor its employees hold any responsibility or liability whatsoever for the services I provide, nor for the consequences of the provision of such services, including personal accident, damage to client's property etc. I declare that all the information given is true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, London Healthcare Agency has the right to terminate my membership form the register of members. I declare that all information given is true in every respect. I have read and understood the Terms and Conditions of Engagement and agree to comply with the current Health & Safety at Work Act. I have read and agree to abide by London Healthcare Agency's Conditions of Membership.