Member Pre-Enrolment Application Form

Your details

Complete all member details, then we'll verify your email before continuing.

Required field

New enrollee

Yes No

PERSONAL INFORMATION

First name

Middle name

Last name

Date of birth

Format: day / month / year — e.g. 04/03/1985

Gender

Male Female Prefer not to say

CONTACT INFORMATION

Email address

Telephone number

GOVERNMENT IDENTIFIERS

NIB number

NIB = National Insurance Board number, on your NIB card or pay slip.

Island

EMPLOYMENT INFORMATION

Ministry / department

Department code

Printed on your government ID or from your HR office.

Employee ID

Your payroll employee number — different from your NIB number.

Employee code

A short department/role code from your HR office — not the same as your Employee ID.

We'll send a 6-digit code to confirm this is really you and match your record before continuing.

Email address

Enter the 6-digit code

Sent to menno@orangecay.com. Check your spam or junk folder if it hasn't arrived within a few minutes.

*If you can’t find your code, try to check your spam or junk folder.