Membership cancellation form
A.
Details
First name*
This field is required
Surname*
This field is required
Employee Number / ID
Email address*
This field is required
Please enter a valid email address
This type of email address is internal to LBG and cannot be used externally. Please provide an external email address.
Home address
Start typing your address
Enter address manually
Contact address
Change address
Address line 1*
This field is required
Address line 2
Town*
This field is required
County
Postcode*
This field is required
B.
Employment details
Employer*
Select an option
Associate
Bank of Scotland
Communisis
Diligenta
E.Surv
Embark
Halifax Branch
LBG Offshore
LBG Site
Lloyds Branch
Sainsburys Bank
Schroders Personal Wealth
Scottish Widows
TSB Branch
TSB Site
Tuskerdirect Limited
Union Insurance
Utmost
This field is required
Workplace address*
Select your employer first
This field is required
Start typing your address
Enter address manually
Contact address
Change address
Address line 1*
This field is required
Address line 2
Town*
This field is required
County
Postcode*
This field is required
C.
Cancellation
Reason for cancelling your membership?*
Select an option
Left / leaving employer
Financial reasons
Do not need union
Subscriptions too much
Unhappy with union
Joined another union
This field is required
Are you leaving or have left your current employer?*
Yes
No
This field is required
Reason for cancelling
This field is required
Date left / leaving employer*
DD
MM
YYYY
Please enter a valid date
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