Employee Information Form

Refcom Elite
Old Mansion House, Eamont Bridge, Penrith, Cumbria CA10 2BX
Telephone: 01768 860409
Website: www.refcom.org.uk
Email: [email protected]
Refcom Elite Company Registration
Application Form
1. Company
Company Name:
Public Limited Company
Private Limited Company
Sole Trader
Other (e.g. Local Authority, Health Trust etc)
Website address:
Position in Company:
Principal Contact Name:
Principal email address:
Is your company a member of BESA?
If yes, please provide your BESA registration (HV) number:
2. Details of RAC and HP Engineer(s)
Operatives must be certificated as competent to handle refrigerants. Satisfactory proof of competence would be registration on the ACRIB/SKILLcard register of Operatives competent in
the handling of refrigerants. In order to obtain registration an applicant must provide a copy of a current certificate of competence in the safe handling of refrigerants (either City and
Guilds 2079, CITB J11-14, City and Guilds 6187 01-06 - unit 230/530 or City and Guilds 7189 02-03 - unit 209/509).
Inspection of original City and Guilds and/or CITB certificates may be required at the time of inspection of the business.
Number of engineers employed in work involving refrigerants
Number of engineers certificated in the safe handling of refrigerants
v5 May 2016
Certificate type e.g. C&G
2079 or CITB J11-14
Date Awarded
Expiry Date
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3. Waste Carrier, Refrigerant Recovery and F Gas Certification Details
Registered Waste Carrier Certificate (Upper Tier)
Expiry Date
Registration Number:
Issued By:
Refrigerant Recovery Equipment
Refcom Elite requires full and accurate records to be kept of all refrigerant transactions i.e. used or recovered. This also includes
logging of all refrigerant coming into the business via pre-charged units. You will need to be registered with your local Council
as a carrier of controlled waste. This is in addition to the requirements of the Hazardous Waste Regulations.
The number of recovery pumps to operatives is not fixed; however a ratio of one pump to one operative is ideal where the
operatives are mobile and travel to different sites. Calibrated weighing devices are also to be used when refrigerant is ordered
from or returned to a supplier.
Do you own an appropriate number of recovery machines?
Tick as appropriate
Please provide details:
Do you have appropriate calibrated weighing facilities for the
bottles used?
Tick as appropriate
Please provide details:
F-Gas Company Certification Details:
Do you hold F Gas Company Certification?
Tick as appropriate
Name of Certification Body that issued your certificate:
Registration Number:
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4. Payment Details
Fees inclusive of VAT current rate
BESA member
Annual renewal
Size of Business
Initial annual registration
and inspection
Micro (sole trader)
Small (2-9 engineers)
No charge for
Medium (10-49 engineers)
BESA members
Large (50+ engineers)
Multisite application
Credit/Debit card - please complete details below
Card type:
Visa Credit
Valid from:
Cheque - payable to Refcom Ltd
Visa Delta/Electron
Expiry date:
Visa Electron
(if applicable)
Issue Number
(Last three digits on signature strip)
Security Code:
Card Number:
Cardholder's name as it appears on card:
5. Declaration
The Declaration is to be signed by a senior manager or director as the authorised representative of the Business.
I confirm that (on behalf of the named business included within this application)
All information and documentation provided in support of this application is complete and accurate;
I/we will abide by the Terms of Registration of the Refcom Elite voluntary registration scheme.
I understand that:
Following submission of this application Refcom Elite will arrange for an initial on-site inspection for the purpose of checking on procedures and equipment relating to refrigerant handling. For the purpose of this
inspection I agree I will allow access to my premises when required by an inspector.
I acknowledge that the following information will be publicly available on the listing of Refcom Elite businesses:
business name, or
my name (in case of self-employed/sole trader applications)
unique registration number
membership status
contact details as specified in section 1
If you do not want this information to be publicly available, tick here
I also hereby confirm on behalf of the business named in this application that the information contained in this document is correct, that any changes in circumstances will be notified to Refcom Elite in writing.
I agree that Refcom Ltd may use the information disclosed in this application for the following purposes:
- to help improve the content of the Refcom website and the service Refcom offers to certified businesses
- for internal audit purposes
- to provide you with the information about Refcom and associated industry matters;
- to provide certificated businesses with information regarding updates or additional services available from Refcom Ltd and its associated companies;
Name of individual signing the declaration:
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6. Checklist
Once you have completed all the relevant sections, to help us to help you get your Refcom Elite registration a quickly as possible,
please do a final check to make sure your application is complete.
Check 1 - Have you enclosed the original copy of the registration certificate as a carrier of controlled waste?
Check 2 - Have you enclosed a certificate of competency (ACRIB SKILLcard or RAC Related Engineering Services SKILLcard
and City and Guilds 2079 or CITB J11-14) for each of your engineers?
Check 3 - Have you enclosed copies of purchase/hire invoice(s) for refrigerant recovery equipment and calibrated weighing
Check 4 - If you have a written 'method statement' for your company's refrigerant handling systems then please enclose a
Check 5 - have you enclosed your payment of the Registration fee(s)?
Check 6 - Have you enclosed your completed ACRIB SKILLcard registration form(s) (if applicable)
Please return this form with supporting documentation to:
Refcom Ltd
Old Mansion House
Eamont Bridge
CA10 2BX
Tel: 01768 860409
Fax: 01768 860401
Email: [email protected]
Website: www.refcom.org.uk
Full particulars on registration requirements are detailed in the Scheme Operation Booklet at www.refcom.org.uk. In summary the registration criteria is:
Refcom Elite Inspection - BESA member
company must allow access to their premises when required for the purpose of inspecting records and equipment and
verifying statements made in the application. Inspections will form part of the BESA Inspection and Assessment regime.
Refcom Elite Inspection - Non BESA member
company must allow access to their premises when required for the purpose of inspecting records and equipment and
verifying statements made in the application. Where appropriate, an inspector may agree to carry out a repeat inspection
after deficiencies have been remedied but this will be at the expense of the company. On application an initial on-site
inspection will be carried out, thereafter site inspections will be administered every three years (with desk-top audits in the
preceding years.) In cases of multi-site applications all business sites will be inspection over a three year rolling programme.
If a company fails to satisfy the inspector on initial inspection the application for registration will not be accepted.
Registration fees are non refundable.
company must be registered as a carrier of controlled waste
refrigerant recovery equipment must be used, copy invoices are required as proof of use.
engineers must be certified as competent to handle refrigerants. Membership of ACRIB or *Engineering Services
SKILLcard for your and all sub-contracted refrigerant handling engineers is a condition of Refcom Elite registration.
In addition, copies of current F gas qualifications for all engineers are required.
company must conform to all current legislation
company must be able to demonstrate an auditable procedure is in place which will enable proper control of
refrigerant movement
Once a company has undergone a satisfactory inspection they will receive a certificate of registration from the scheme.
* Engineers must hold either a Blue or Gold Refrigeration/Air Conditioning Technician/Engineer Engineering Services SKILLcard.
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