4SX Voluntary and Community Sector Consortium

Application for Membership Form

Where you are asked to make additional statements, please restrict your answers to a maximum of 250 words.Please complete all boxes, marking ‘n/a’ if not applicable.

Once complete, please emailthe form to

Name of Organisation:
Name of main contact person:
Tel:
Email:
Registered Office Address:
Address for correspondence if different from above:
Date the organisation was started:

In completing the following questions please refer to the eligibility criteria section of the Membership Prospectus. Your responses will be treated in confidence. 4SXConsortium will ensure the safe and secure storage of all application documentation and the information you submit will be used solely for the purpose of assessing your application for Consortium membership. All applications will be considered by the 4SX Consortium Board.

Please indicate which level of membership you are applying for. The consortium has two levels of membership; Full and Associate. Full membership is available to organisations that fully meet the consortium’s five eligibility criteria. Associate membership is for organisations that are working towards meeting the eligibility criteria.

Full membership
Associate membership

Question 1:Does your organisation operate in the voluntary and community sector?

Yes
No

Question 2: What is the legal status of your organisation?

Please complete all that apply, including registration numbers

Legal Structure / Registration No.
Company limited by guarantee
Registered charity
Community Interest Company (limited by shares)
Community Interest Company (limited by guarantee)
Charitable Trust
Unincorporated association
Charitable Incorporated Organisation
Other (please describe)

Place of registration (if applicable)

VAT number (if applicable)

Name of ultimate holding or parent company or subsidiary companies including addresses and an explanation of group structure and internal relationships.

Company registration number of ultimate holding or parent company or subsidiary companies.

How many staff does your organisation currently employ? Please don’t put FTE.

What was the turnover of your organisation in the last financial year?

Question 3: Describe your beneficiaries, service users or clients

Question 4: What is the area of benefit as defined in your governing document?

Question 5: Describe where in Essex you provide services and what those services are.

Question 6: Please use the space below to provide a brief statement in support of your commitment to working as part of the Consortium, including explaining how you will contribute to the Consortium’s values

Question 7: Please use the space below to provide a brief statement of what sorts of expertise and skills you have that you would be prepared to share with fellow Consortium members, along with an indication of how you might go about this:

Please tick the eligibility criteria you current meet.

Voluntary and community sector or not for profit / Area of operation
PQQ compliance / Information management capability
Commitment to consortium working

Declaration

This declaration needs to be completed by all applicants. It must be submitted by two authorised people on behalf of the organisation, at least one of whom should be a member of the governing body (if it is not practical or feasible to get a member of the governing body to sign the declaration, e.g. because you are part of a national structure, another suitable individual with full delegated authority will be acceptable as a signatory).

We hereby apply to become a full/associate member of 4SX and agree to be bound by its memorandum and articles of association and any rules made under these. We confirm that our organisation:

  1. supports the 4SX consortiums aims and work and;
  2. has objects that are consistent with the 4SX consortium

We agree that the 4SX consortium may give out information about our organisation to other members.

We:

  1. Confirm that we are duly authorised to submit this declaration on behalf of the applicant organisation.
  2. Confirm that this application has been authorised by the management committee, other governing body or board.
  3. Confirm that we have read the Membership Prospectus and that we share the values of the Consortium.
  4. Certify that the information given in this application is true and confirm that any enclosures are current, accurate and adopted or approved by our organisation.
  5. Understand that, if we make any seriously misleading statements (whether deliberate or accidental) at any stage during the application process, or if we knowingly withhold any information, this could make our application invalid.
  6. Understand that the Consortium Board may request additional information from us in support of our application.
  7. Understand that the decision of the Consortium Board is final.
  8. Understand that a copy of this form and any supporting papers, together with the written decision of the Consortium Board, will be retained on record by the Consortium.
  9. Agree, if this membership application is successful, to abide by the standing orders and rules of the Consortium.

Person One (Main Contact)
Name (please print)
Position
Dated
Person Two
Name (please print)
Position
Dated