Contractor Registration

Business Name(Required)
Trading As
(if applicable)
Name of business owner(Required)
You have a valid C2 or Tax Clearance Certificate(Required)
This is a requirement of the NSAI ETICS scheme
- YES
- NO
Upload your Tax Clearance Certificate(Required)
Max. file size: 5 MB.

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Business Details
Primary Contact(Required)
First Last
Primary Contact - Mobile #(Required)
normal format - (083 123 4567)
Primary Email Address(Required)
Business Address(Required)
Street Address Address Line 2 City County / State / Region Eircode Country
Business Phone(Required)
Number of Employees(Required)
include your employees, self-employed workers, temporary staff
Please enter a number greater than or equal to 1.

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Additional Business contact information
fill in as relevant
Secondary Contact
First Last
Secondary Contact - Phone #
Secondary Contact - Email Address

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Health & Safety
We require as copy of your company Safety Statement - if you do not have one, then Premium Facades can offer this to you for a nominal cost of €150.
Do you have a Company Safety Statement?(Required)
- YES
- NO
Upload your Company Safety Statement(Required)
Max. file size: 5 MB.
How many years has the company been in operation within the industry?(Required)
Comment
Have you example photos of previous jobs which you can supply to Premium Facades to show your standard of work?(Required)
- YES
- NO

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Digital paperwork
Premium Facades use a mobile app to replace paper forms. We require an email address from you which you will use on this app while working with our certified ETIC system. This email address should be accessible to you for receiving email - copies of your completed forms will be sent to this address. Your installation operative staff will also use this email as the login username to the Fastfield Forms shared account you use for gathering information and submitting your project paperwork while using the Premium Facades ETICS systems for your customer installations.
Forms app - Email address for account(Required)
Enter Email Confirm Email

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Supervisor #1 details
Supervisor #1 Name(Required)
First Last
Supervisor #1 - Position within company(Required)
Supervisor #1 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Supervisor #1 - SafePass expiry date(Required)
DD slash MM slash YYYY
Supervisor #1 - Mobile phone number(Required)
please enter in the international format 3538312345678
Supervisor #1 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 2nd Supervisor?(Required)
- YES
- NO

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Supervisor #2 details
Supervisor #2 Name(Required)
First Last
Supervisor #2 - Position within company(Required)
Supervisor #2- Photo of SafePass card(Required)
Max. file size: 5 MB.
Supervisor #2 - SafePass expiry date(Required)
DD slash MM slash YYYY
Supervisor #2 - Mobile phone number(Required)
please enter in the international format 3538312345678
Supervisor #2 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 3rd Supervisor?(Required)
- YES
- NO

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Supervisor #3 details
Supervisor #3 Name(Required)
First Last
Supervisor #3 - Position within company(Required)
Supervisor #3- Photo of SafePass card(Required)
Max. file size: 5 MB.
Supervisor #3 - SafePass expiry date(Required)
DD slash MM slash YYYY
Supervisor #3 - Mobile phone number(Required)
please enter in the international format 3538312345678
Supervisor #3 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.

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Installation Operative #1 details
Operative #1 Name(Required)
First Last
Operative #1 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #1 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #1 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #1 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 2nd Operative?(Required)
- YES
- NO

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Installation Operative #2 details
Operative #2 Name(Required)
First Last
Operative #2 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #2 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #2 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #2 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 3rd Operative?(Required)
- YES
- NO

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Installation Operative #3 details
Operative #3 Name(Required)
First Last
Operative #3 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #3 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #3 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #3 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 4th Operative?(Required)
- YES
- NO

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Installation Operative #4 details
Operative #4 Name(Required)
First Last
Operative #4 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #4 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #4 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #4 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 5th Operative?(Required)
- YES
- NO

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Installation Operative #5 details
Operative #5 Name(Required)
First Last
Operative #5 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #5 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #5 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #5 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 6th Operative?(Required)
- YES
- NO

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Installation Operative #6 details
Operative #6 Name(Required)
First Last
Operative #6 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #6 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #6 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #6 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 7th Operative?(Required)
- YES
- NO

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Installation Operative #7 details
Operative #7 Name(Required)
First Last
Operative #7 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #7 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #7 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #7 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.
Do you want to add a 8th Operative?(Required)
- YES
- NO

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Installation Operative #8 details
Operative #8 Name(Required)
First Last
Operative #8 - Photo of SafePass card(Required)
Max. file size: 5 MB.
Operative #8 - SafePass expiry date(Required)
DD slash MM slash YYYY
Operative #8 - Mobile phone number(Required)
please enter in the international format 3538312345678
Operative #8 - photo for ID card
if you do not provide this now, you will be required to produce this by email after submitting this form.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB.

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Insurance details
Please tick if you have the following insurances
Employers Liability
- Employers Liability
Attach Employers Liability(Required)
Max. file size: 5 MB.
Public Liability
- Public Liability
Attach Public Liability(Required)
Max. file size: 5 MB.
Professional Indemnity
- Professional Indemnity
Attach Professional Indemnity(Required)
Max. file size: 5 MB.

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Declarations
Your Name (on behalf of company)(Required)
First Last
Role(Required)
Acknowledgement 1(Required)
I confirm that the information given by me in the form above is true and correct.
I agree
Acknowledgement 2(Required)
I agree to providing Premium Facades with the necessary documentation listed throughout this form. Until such time as all necessary documents have been provided and validated, I understand and acknowledge that I may not be certified to install ETICS products under the Premium Facades Agrement Certification.
I agree
Signature(Required)
On a phone, please rotate your screen to landscape before signing.

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Step 1 of 18

Business Details

Additional Business contact information

Health & Safety

Digital paperwork

Supervisor #1 details

Supervisor #2 details

Supervisor #3 details

Installation Operative #1 details

Installation Operative #2 details

Installation Operative #3 details

Installation Operative #4 details

Installation Operative #5 details

Installation Operative #6 details

Installation Operative #7 details

Installation Operative #8 details

Insurance details

Declarations