Set up a Mandate

The work of Lothian LDC & GDP Sub-Committee is entirely funded by voluntary mandates from GDPs in the Lothian area. If you have not already set up a mandate, please print one off by clicking on the link below. Completed mandates should be posted to our Secretary, Mark McCutcheon, whose address is on the mandate form. Remember, mandate holders are entitled to a substantial reduction in booking fees for CPD courses organised by Lothian LDC and may be eligible for reductions on similar courses run by partner organisations.

To set up an LDC mandate, click here

Or complete the digital mandate below:

To: Lothian NHS Board

I, the undersigned
Full name (As appears on GDC register)*
First Last
Email*
GDC Registered Address*
Street Address Address Line 2 City ZIP / Postal Code
Having entered into a written agreement with Lothian NHS Board (hereinafter called “the Board”) whereby I have undertaken the treatment of persons under the National Health Service Acts, do hereby authorise and request the Practitioner Services, NHS National Services Scotland/Common Services Agency (herein called the “Agency”) (unless and until this authority and request shall to be revoked) to deduct from the sums due to me at the end of each month such an amount, not exceeding 0.2 of one penny per cent of my remuneration from the Agency as may from time to time be resolved upon and requisitioned by Greater Glasgow and Clyde Area Local Dental Committee (General Practitioners) (hereinafter referred to as “the Committee”). This mandate cancels any previous Mandate granted by me to the Agency.

I hereby authorise and request the Agency to pay all such sums as may be deducted as aforesaid to the Treasurer for the time being of the Committee (or as the Treasurer may direct), to be applied in meeting the expenses of the Committee and in making such other payments as may be resolved upon by the Committee, providing always that the receipt of the Treasurer or other authorised official of the Committee shall, under all circumstances and in any event, be a full and sufficient discharge to the Agency for all sums paid by the Agency as aforesaid; and the Agency shall not in any way be concerned with or have any authority to enquire as to the application of the sums so paid; and I agree to indemnify the Agency of all claims in connection with the deduction of the said sums or anything done or omitted to be done under the authority herein contained.

I consent to my personal data being shared to the Agency in order for the purpose of executing this mandate.
GDC Number*
List number(s) held with GG&C Health Board*
I confirm that I am authorising you to instruct PSD to take a levy from my NHS Schedule each month.*
- Yes, I have read the terms and conditions and I understand you will take a levy form my NHS Schedule each month
Signature*