APPLICATION FORM SALARY SACRIFICE SPORTS TRAINING VILLAGE SALARY EXCHANGE

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WESTWOOD NURSERY

Application Form

Salary Sacrifice: Sports Training Village Salary Exchange Scheme

1. General details - (all fields must be completed)

Surname:

Job title:

Date of Birth:

First name:

Department:

Home address:

Email:

Payroll number:

Mobile:

2. Membership options

Membership type

Annual Fee in pounds sterling

Please sign in appropriate box

Team Bath+	£49.00 per month
Gym + Classes	£39.00 per month
Gym Off-Peak + Classes	£27.50 per month
Swimming	£25.00 per month
Athletics	£18.00 per month

3. Date from which you wish to participate in Salary Sacrifice (NB must be from 1^st of the month only)

Date: until annual renewal date (12 months from joining date)

N.B. Cancellation option only available on 12 month anniversary date from joining – Each year you will enter into a new 12 month contract on roll over.

I understand and agree that as a participant in Salary Sacrifice Salary Exchange Scheme my gross salary will be reduced by an amount equivalent to the above selected membership at the Sports Training Village and that the following conditions will apply:

The University will pay the membership cost direct to the Sports Training Village
I may amend my participation only at the annual renewal date or when I leave the employment of the University or if there is a lifestyle change as defined in the Request for Change form
I understand that this salary reduction constitutes a formal change to my contract of employment. All other terms and conditions of employment remain unchanged.
The Sports Training Village reviews all membership rates on 1^st August and rates may therefore increase with effect from this date. We will notify you of any increase in rates with a revised membership rate for Salary Sacrifice.

Signed:

Date:

Please complete this form and send to Membership Retention Administration, Sports Training Village, University of Bath. E-mail to: [email protected] Please keep a copy of this form for your own records.

Eligibility checked: Date:

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