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Employer Details

Employer Name(Required)

First Last

Your Email Address(Required)

Your Mobile Number(Required)

Address(Required)

Street Address Address Line 2 City County / State / Region Postcode Country

Accounts Office Reference Number(Required)

Employer Reference Number(Required)

Employee's personal details

1) Last Name(Required)

2) First Name(Required)

Do not enter initials or shortened names for example,Jim for James or Liz for Elizabeth

3) Address(Required)

4) What is your sex?(Required)

As shown on your birth certificate or gender recognition certificate

Male

Female

5) National Insurance number(Required)

6) Date of birth(Required)

7) Employment start date(Required)

Employee statement

These questions will help you to choose the statement that matches your circumstances. The statement you choose helps your employer to apply the correct tax code.

8) Do you have another job?(Required)

Yes (Put an ‘X’ in the statement C box below)

No (Go to question 9)

9) Do you receive payments from a State, workplace or private pension?(Required)

Yes (Put an ‘X’ in the statement C box below)

No (Go to question 10)

10) Since 6 April have you received payments from:(Required)

• another job which has ended or any of the following taxable benefits • Jobseeker’s Allowance (JSA) • Employment and Support Allowance (ESA) • Incapacity Benefit

Yes (Put an ‘X’ in the statement B box below)

Yes (Put an ‘X’ in the statement A box below)

Statement A

Current personal allowance

This is my first job since 6 April and since the 6 April I have not received payments from any of the following: • Jobseeker’s Allowance • Employment and Support Allowance • Incapacity Benefit

Statement B

Current personal allowance on a Week 1/Month 1 basis

Since 6 April I have had another job but I do not have a P45. And/or since the 6 April I have received payments from any of the following: • Jobseeker’s Allowance • Employment and Support Allowance • Incapacity Benefit

Statement C

Tax Code BR

I have another job and/or I am in receipt of a State, workplace or private pension

Declaration

I confirm that the information I’ve given on this form is correct.

Full Name(Required)

Use capital letters

Date(Required)