Apply for Model Cell Biobank Service

To apply to use the Model Cell Biobank you need to complete and return our application pack. You can either do this online or request the application pack be sent to you by calling our customer care line on 0800 368 9540 (Monday- Friday 9am-3pm) or completing the request form below.

Apply online

Your application will be reviewed by the Charity who will decide if you are eligible for the service.

In order to apply it must be at least 4 weeks until your due date. This is due to the time it takes to process your application. If your due date is within the 4 weeks and you have a medical need for storing the stem cells then please email us at cs@modelcellbiobank.org.

Please note: We are currently not able to accept applications from Northern Ireland or the Isle of Man.

Important – before completing the online application you will need to have the following documents, ready to upload. If you don’t have the documents to hand, simply save the form once completed and a link will be emailed to you to enable you to upload the documents when you are ready.

The completed GP eligibility form (download it here)

For the Fully Funded Service:

The last 3 statements for the benefits you are receiving or a letter confirming that you are receipt of benefits (dated within the last 3 months).

For the Part Funded Service:

A current Council Tax Statement or other evidence approved by LMRUK providing details of the adults in your household (each a household member);

for each household member details and evidence of:-

Savings and investments and of any income received from savings and investments;

all state benefits, NASS support, Tax Credits, grants and other financial assistance received by each household member (evidence should include confirmation of nature and amount of benefit and to whom it is paid);

any other income received from any other source (e.g. pensions)

for each household member who is employed

payslips for the last three months;

latest P60

and

latest P11D (if applicable).

for each household member who is self-employed

full accounts for the past 12 months;

a copy of the last self-assessment tax return submitted to HMRC

Do I qualify?

Our charity offers umbilical cord blood banking service to anyone who meets one of the following criteria:

The stem cells from your baby, could be used to treat your baby, or another member of the family, for a medically proven treatment. A specialist’s recommendation would be necessary.
there is any cancer in the immediate family.

If you are in receipt of Housing Benefit, Council Tax Support, or Universal Credit, you may be eligible to receive a full contribution towards the funding of your participation in the Service. If the income for each adult in your household (excluding income from state benefits) (Total Household Income) is less than or equal to £40,000 then you may be eligible to receive a part contribution towards the funding of your participation in the Service. Click here to view the threshold table.

For more information please read our approval policy.

For some conditions or diseases it is not recommended that the stem cells are collected or used to treat someone else (for allogeneic use). We will of course advise you if this is the case. If your application is accepted we will contact you to arrange to set up the service for you.

Want to learn more?
View the Model Cell Biobank brochure

Please note: We are currently not able to accept applications from Northern Ireland or the Isle of Man.

Request your Application Pack Form

Complete the form below to request your Application Pack

Complete your Application online

Complete the form below to apply for the Model Cell Biobank service

Step 1 of 7

How did you hear about the service?(Required)

Mother's Details

Mother's name

First Name Last Name

Mother's Home Address

Street Address Address Line 2 City State / Province / Region Postcode

Mother's Mobile Number

Mother's Home Number

Mother's DOB

Mother's Email(Required)

Partner's Details

Partner's name

First Name Last Name

Partner's Mobile Number

Birthing Details

Expected Delivery Date(Required)

Number of Previous Births

Birth Plan

Natural Delivery

Planned Caesarean

Cord Blood to be Collected by

Midwife

Phlebotomist (arranged by the charity)

Name of Hospital

Hospital address

Street Address Address Line 2 City Postcode

Please download the form below for your doctor to complete and return to you

Download GP form

Cord Blood Storage Agreement

2. Collection of the Sample(Required)

2.1 Smart Cells on behalf of LMRUK will organise and book a third party phlebotomist which you will manage. Please note the phlebotomy service is not part of Smart Cells as it is a third party provider and it is your responsibility to liaise with the phlebotomist directly and manage these communications.

2.2 You acknowledge and agree that if the Sample is not collected in accordance with the collection procedure protocol, that it may affect the viability of the Sample for storage and/or future use. You further understand that if the Sample is not collected by a trained and licensed person, SCI may be required to destroy the Sample by the UK Regulatory Authority.

2.3 You understand that the Sample is normally discarded after delivery, appropriated for medical research or stored in a public banking facility and that the decision to collect, process and store your child’s Sample by LMRUK & SCI is a voluntary act on your part.

2.4 You understand that there are risks with any medical procedure, that there may be additional considerations or unforeseeable circumstances during the delivery of your child which may affect the collection of the Sample. The safety and care of the child and mother are of primary concern. You therefore acknowledge and agree that a qualified medical professional may, for any reason and at their discretion, refuse to collect the Sample. This is not something within the control of LMRUK & SCI.

2.5 Once the Sample(s) are collected, it is your responsibility to ensure that the Cord Blood Identification Form is signed to confirm that it is your child’s Sample contained in the collection kit. If you have more than one child and have more than one collection kit, you must clearly identify each child on their respective collection kit.

2.6 LMRUK & SCI cannot be held responsible for any loss, damage or deterioration of the sample during transit from the collection centre to SCI.

2.7 It is helpful for phlebotomists to photograph the umbilical cord and placenta following delivery to assist with any investigations in the event of a sub-optimal cord blood collection. All such photographs are anonymised and are only shared with Smart Cells International.

2.8 It is Your responsibility to ring SCI immediately after your sample has been collected to arrange for your kit collection.

Read and understood

4. Processing, Storage and Withdrawal(Required)

4.1 You are responsible for contacting SCI as soon as possible following the birth of your child in order that a courier can be arranged by SCI on behalf of LMRUK to transport the Sample to the SCI processing and storage facility.

4.2 SCI appoints a courier for the transportation of the Sample to the Facility. Details of how to pack the Sample to ensure safe transportation and delivery are included in your collection kit. On receipt, your Cord Blood Sample will be processed and stored at our facility in the UK.

4.3 You consent to the following activities being undertaken by LMRUK & SCI:

4.3.1 performing all tests on the Sample required by the UK Regulatory Authority.
4.3.2 the transfer of the Sample from one Facility to another Facility, following the provision to you of written notice; and
4.3.3 the transfer of the location of any Facility at which the Sample is stored following the provision to you of written notice.

4.4 The Sample, as well as any maternal blood sample, shall at all times be owned by you and the Sample shall be subject to your exclusive control until the child reaches the age of 18, when ownership and control over the Sample shall automatically transfer to the child.

4.5 No additional costs will be incurred for the transportation of the sample at any time if required for therapeutic use.

4.6 If before the child reaches the age of 18 another person is granted parental responsibility for that child, that person may enforce your rights under this agreement. We reserve the right to request supporting evidence of legal guardianship, including documents issued by a court of law, before acting on the instructions of any person purporting to have parental responsibility for your child.

4.7 LMRUK & SCI will only accept requests for release of stored samples from you if the child is under 18 when the request is made, or from the child if he or she has reached the age of 18 when the request is made.

4.8 Once the child reaches 18, in the event of any conflict between your request and the requests of your child, we will be bound by the requests of your child.

4.9 LMRUK & SCI’s obligations and liabilities are expressly limited to the services described in sections 2, 3 and 4 above and no other services are provided. SCI is not responsible for providing any other services.

4.10 LMRUK & SCI cannot be held responsible for any loss, damage or deterioration of the Sample once it has left SCI’s possession and control for provision to a third party for any reason.

4.11 If a sample is required for therapeutic use, LMRUK & SCI will arrange release of the sample according to SCI’s procedure and current regulatory requirements. The transplant centre will be responsible for any ongoing storage, transit, processing, testing, clinical use or disposal.

Read and understood

5. Terms and Termination(Required)

5.1 The Sample shall be stored for the term paid for by you, subject to the conditions in this paragraph.

5.2 LMRUK & SCI reserve the right to refuse to process and/or store Sample storage for any reasonable reason, including but not limited to:

(a) if the Sample has been unlawfully procured
(b) if the volume of cord blood is less than our minimum requirement
(c) if the Sample is determined to be unsuitable for storage
(d) the Sample has been incorrectly packaged
(e) if any part of the collection kit has been replaced
(f) if the maternal blood donor has tested positive for HIV.

5.3 In the event that LMRUK & SCI refuse to process or store the Sample pursuant to paragraph 5.2, you consent to LRMUK & SCI destroying the Sample.

5.4 LMRUK & SCI sets a minimum cell count(s) for storing cord blood units based on current transplant science/technology. In the event your cord blood unit is below these criteria, you will be notified. If you wish to continue to store that unit, processing and storage fees will apply.

5.5 This Agreement may be cancelled by you at any time prior to the collection of the Sample at birth by written notice to LMRUK. You will not be charged the balance (if using the part funded service).

5.6 If the Sample is accepted for storage, the Sample will be stored at our Facility and this Agreement shall be in full force and effect for the period of storage paid for, unless otherwise terminated on its terms.

5.7 LMRUK will pay for the service of collecting, processing and storing your child’s stem cells provided that you are deemed eligible by the charity. If however you decide once the cord stem cells have been collected, processed and stored to withdraw your consent no longer wish to store your child’s stem cells, then a fee of £670 or if the sum exceeds at that time then the whole sum will be payable to cover the costs incurred by the charity.

5.8 LMRUK will notify the child of the end of the storage period six months prior to the end of the twenty five (25) year storage term by writing to the last address you have given to LMRUK. We also attempt to contact you via email or telephone call if we do not receive a response to our notice within 60 days of writing to the child, we reserve the right to dispose of and destroy the stored Sample in each case without sending any further notice to you.

5.9 If LMRUK does not receive a response from you after sending notice to the address last notified to LMRUK or to the address of your child if they are over 18 and you have provided their address details, LMRUK shall have the right to, without further notice, destroy the Sample.

5.10 If you elect to continue to permit LMRUK to continue store the Sample on your behalf, LMRUK will invoice you for continuing storage costs at its then current rates stated in the notice.

5.11 If you wish to continue to store the Sample with LMRUK, you shall make full payment for the next period of storage as specified at the time.

5.12 The Sample will be destroyed unless invoices for continuing storage are paid within 30 days.

5.13 If at any time you request that the Sample is to be transferred, then we will release the Sample to you. We will not cover the cost or be responsible for the preparation of the sample, shipping containers, transportation or future storage.

Read and understood

7. Limit of LMRUK’s & SCI’s Liability(Required)

7.1 If due to the default or negligence of SCI or its contractors the Sample is damaged or destroyed, the maximum amount for which SCI shall be liable to you shall be £10,000 (ten thousand UK pounds).

7.2 If SCI or its contractors through their default or negligence cause damage to real or personal property (other than to the Sample) or cause any other loss or damage (save for personal injury or death caused by their negligence), their liability shall be limited to the amount of the fees paid by you pursuant to this Agreement, less any sums payable pursuant to paragraph 7.1.

7.3 Without prejudice to any other limitation (whether effective or not) of LMRUK & SCI’s liability, LMRUK & SCI shall not in any circumstances be liable (whether in contract, tort or for breach of statutory duty or otherwise) for any loss of profits, use, opportunity, goodwill, business or anticipated savings, for any indirect or consequential losses or for any third party claims in connection with this Agreement/the Sample (in each case irrespective of any negligence or other act, default or omission of LMRUK & SCI (or its employees or agents) and regardless of whether such loss or claim was foreseeable or not or whether LMRUK & SCI has been informed of the possibility of such loss).

7.4 In the case of damage by a third party, LMRUK does not bear any moral and material responsibility to the client.

7.5 LMRUK & SCI or personnel collecting the Sample shall not be liable to you when due to unforeseen circumstances, the collection of the Sample is not possible, or the amount of blood taken proves to be insufficient or the Sample is contaminated or otherwise compromised.

7.6 You acknowledge and understand that we shall not be liable to you, or be considered to be in breach of this Agreement, because of any delay in performing, or any failure to perform, any of our obligations if the delay or failure was due to your acts or omissions.

7.7 It shall not be a breach of this Agreement if LMRUK & SCI is unable to timely perform or to perform at all any of its obligations under this Agreement due to circumstances beyond our reasonable control, including but not limited to, industrial action, war, and acts of terrorism, acts of God, traffic accidents, changes in legislation or prohibition or enactment of any kind.

7.8 LMRUK & SCI shall not be liable to you for any loss or damage suffered by you or any other person as a result of your failure to comply with the terms of this Agreement.

Read and understood

8. Confidentiality and Data Protection(Required)

8.1 LMRUK & SCI will use all reasonable endeavours to keep confidential all information relating to you and your child. All Samples to be tested will be labelled with unique reference numbers and bar coded.

8.2 LMRUK & SCI s registered under the Data Protection Act 2018 and will process all personal data in accordance with its obligations under that Act. By signing this Agreement, you consent to LMRUK & SCI, for the purposes of this Agreement and/or as from time to time required by UK law or the UK Regulatory Authority:

(a) collecting, recording, storing (on our secure database and database backup) checking, transferring (within the EEA) and processing your medical (including sensitive data) and personal data and the medical (including sensitive data) and personal data of your child (together, “the Data”), including the results of any tests on the Sample and maternal blood test results;
(b) supplying the Data to third parties to which LMRUK & SCI has subcontracted any of its obligations to you under this Agreement or to which LMRUK & SCI transfers the Sample pursuant to paragraph 11.2, and for those third parties to record, store, check, and transfer (to or within the EEA) the Data for the purpose of fulfilling those subcontracted obligations;
(c) disclosing Data as required by law and/or to your child’s medical practitioner on request;
(d) making Data available to any Company in the same group as SCI, the UK Regulatory Authority and potential purchasers of the Company and/or of substantially all its assets relating to the business of the collection and storage of stem cells and cord blood; and
(e) LMRUK & SCI supplying copies of its records relating to the Sample, including the Data, to a third party (who might be located outside the EEA) if the Sample is, at your request, transferred to that third party, whether for storage or use.

8.3 Save as otherwise provided in this paragraph 9, LMRUK & SCI agrees that it will not, without receiving your permission in writing, show or pass the Data regarding your Sample or maternal blood tests to a third party.

Read and understood

S MD 169 – Revision 1 25/01/2023

ABOUT THESE TERMS & CONDITIONS

These Terms and Conditions set out:-

the eligibility criteria applicable for those wishing to apply for funding to participate in Leukaemia & Myeloma Research UK Ltd (LMRUK)’s Model Cell Biobank Service (Service);
the funding available and fees payable by you if you meet the eligibility criteria; and
LMRUK’s refund policy should your cord blood not meet the Tissue Bank’s acceptance criteria for processing and storage.

The terms and conditions relating to the collection, processing and storage of the cord blood stem cells are not covered by these terms and conditions but are dealt with in the Model Cell Biobank Service - Storage Agreement & Consent Form that must also be signed in order for the Service to be set up for you.

SERVICE ELIGIBILITY CRITERIA

In order to qualify for the Service you must meet one of the following criteria:-

Have a history of cancer in your immediate family (son, daughter, spouse/partner, sibling, parent, grandparent, uncle or aunt) confirmed in writing by your doctor;
Have a written recommendation from a specialist approved by LMRUK that a medically proven treatment that the stem cells from your baby could be used to treat your baby or another member of your family.

FUNDING ELIGIBILITY CRITERIA

If you are in receipt of Housing Benefit, Council Tax Support or Universal Credit then you may be eligible to receive funding for 100% of the costs of your participation in the Service.

If the income for each adult in your household (excluding income from state benefits) (Total Household Income) is less than or equal to £40,000 then you may be eligible to receive a contribution towards the funding of your participation in the Service as follows:-

Total Household Income	LMRUK Funding	Fee Payable by you
In receipt of benefit or credit as detailed in funding eligibility criteria	100%	N/A
Up to £28k	90%	£260
Between £28-35k	75%	£650
Between £35-40k	50%	£1300

APPLICATION

In order to apply for the service you need to ensure that you meet our eligibility criteria, the service eligibility criteria and the funding eligibility criteria. If you believe you meet the criteria you need to complete the LMRUK’s application form available on request by either completing the form on our website (https://lmruk.org/model-cell-biobank-apply/) or by calling our customer care line on 0800 368 9540 (Monday-Friday 9am -3pm).

You will be required to submit the following supporting evidence with your application:-

a current Council Tax Statement or other evidence approved by LMRUK providing details of the adults in your household (each a household member);
for each household member details and evidence of:-
- savings and investments and of any income received from savings and investments;
- all state benefits, NASS support, Tax Credits, grants and other financial assistance received by each household member (evidence should include confirmation of nature and amount of benefit and to whom it is paid);
- any other income received from any other source (e.g. pensions)
for each household member who is employed
- payslips for the last three months;
- latest P60; and
- latest P11D (if applicable).
for each household member who is self-employed
- full accounts for the past 12 months;
- a copy of the last self-assessment tax return submitted to HMRC

Evidence should include original documentation and LMRUK reserve the right to request further information and/or evidence where necessary.

LMRUK will contact you in writing within 20 days to either request more information or confirm whether or not your application has been successful.

If your application is successful then LMRUK will request payment of the "Fee payable by you" as set out in the table in the Funding Eligibility Criteria above and, on receipt of payment in full of the amount due from you together with fully signed and completed "Model Cell Biobank Service - Storage Agreement & Consent Form" and these Terms and Conditions LMRUK will arrange for you to participate in the Service.

Please note that the Service will not be set up until payment of any contribution required from you has been received in full.

REFUNDS APPLICABLE TO PARTIALLY FUNDED PARTICIPANTS

If your cord blood fails to reach Smart Cell’s acceptance criteria for processing and storage then the sample will be destroyed and LMRUK will refund you a proportion (based on the table below) of the amount paid by you, normally within 14 working days of LMRUK being informed that the cord blood failed to meet the acceptance criteria for processing and storage.

Total Household Income	% of non-refundable costs payable by you if the sample fails to meet processing criteria	Cord Blood Fails Pre processing	Cord Blood Fails Post Processing
		Refund to you	Refund to you
Up to £28k	10%	£247.50	£235
Between £28-35k	25%	£618.75	£587.50
Between £35-40k	50%	£1237.50	£1175.00

Which service are you applying for?

Fully funded service

Part funded service

Signature(Required)

Print name(Required)

Date(Required)

Before you submit the form, ensure that you have uploaded the following documents. If you don’t have them ready to upload, simply save the form and a link will be emailed to you, to enable you to upload the documents when you are ready.

The completed GP eligibility form (download it here)

For the Fully Funded Service:
The last 3 statements for the benefits you are receiving or a letter confirming that you are receipt of benefits (dated within the last 3 months).

For the Part Funded Service:
A current Council Tax Statement or other evidence approved by LMRUK providing details of the adults in your household (each a household member);

for each household member details and evidence of:-
Savings and investments and of any income received from savings and investments;
all state benefits, NASS support, Tax Credits, grants and other financial assistance received by each household member (evidence should include confirmation of nature and amount of benefit and to whom it is paid);
any other income received from any other source (e.g. pensions)

for each household member who is employed
payslips for the last three months;
latest P60
and
latest P11D (if applicable).

for each household member who is self-employed
full accounts for the past 12 months;
a copy of the last self-assessment tax return submitted to HMRC

Upload documents

Drop files here or

Accepted file types: docx, pdf, Max. file size: 256 MB.

Child	Child your child from whose umbilical cord the Sample is taken;
Sample	the sample of cord blood (and stem cells extracted from cord blood) collected pursuant to this Agreement;
You/your/second party	the person or persons identified as the client on the relevant documentation, or the person(s) having parental responsibility for your child at the relevant time if that should change before they reach the age of 18, and once the child reaches 18, then you/your shall thereafter refer to the child;
SCI/us/we/first party	Smart Cells International Ltd;
LMRUK	Leukaemia & Myeloma Research UK. LMRUK is an official partner of SCI. The Model Cell Biobank service is provided by the Leukaemia and Myeloma Research UK charity. and
UK Regulatory Authority	the regulatory authority in the UK is The Human Tissue Authority (HTA) which at the relevant time regulates the collection (if the Sample is collected in the UK), processing, storage or use of cord blood, and/or stem cells.

Apply for Model Cell Biobank Service

Important – before completing the online application you will need to have the following documents, ready to upload. If you don’t have the documents to hand, simply save the form once completed and a link will be emailed to you to enable you to upload the documents when you are ready.

Do I qualify?

Request your Application Pack Form

Complete your Application online

Mother's Details

Partner's Details

Birthing Details

Statement of Consent

Maternal Health Questionnaire

Cord Blood Storage Agreement

Before you submit the form, ensure that you have uploaded the following documents. If you don’t have them ready to upload, simply save the form and a link will be emailed to you, to enable you to upload the documents when you are ready.

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