My membership

Change your indemnity details

Change your indemnity details

Title

First name

Last name

Membership number

Email address

Name of hospital/practice

Work address

Work postcode

Start date of new work

End date of new work

Or until further notice

Grade/level of responsibility? (e.g. consultant, GP principal)

What specialty are you in?

Give a brief outline of your role, including the training level if applicable, and any new work or procedures you will be undertaking.

If supervised, what is the grade of the supervisor? (e.g. consultant, GP etc.)

How many hours per week will you spend doing this work?

If this work is not indemnified, how much will you earn?

Please list any appropriate training and relevant experience for this work

Gross non-indemnified income you will earn from the start of this work until your renewal date?

Net non-indemnified income you will earn from the start of this work until your renewal date?

Please provide any other relevant details