Please indicate what this form is for. The fields that are displayed will change according to your choice. PLEASE use normal mixed case and NOT ALL CAPITALS as we have to re-type when you do!
New staff
Leaver
Amendment
Pension opt-in
Pension opt-out/Retirement
Your email address (a copy of this form will be sent there)
EMPLOYER name (Please use the name we commonly know - eg NOT Drs Bloggs, Phipps & Farkle, and avoid THE on the front!)
EMPLOYEE surname
EMPLOYEE first name
Male
Female
Gender
Date of Birth
Age
NI Number (must be of the form QQ123456Q). If not known, leave blank
Employee's address in mixed case please with NO COMMAS. Please also supply for leavers so we can be sure an old address is updated before they leave).
This must be the EMPLOYEE's home address.
Employee's postcode
Employee's email
Please provide an email address, work or home, if at all possible
Employee's passport number if available
Are you an NHS Employer for pension purposes?
Yes
No
Eligible for NHS Pension
Not eligible for NHS pension
Please indicate the employee's eligibility for the NHS Pension Scheme. A person in the NHS is eligible for NHS Pension if they are aged 16 to 75, and not already drawing an NHS pension.
If you have marked Not eligible for NHS pension then please explain why in the notes box below
Employed as
Department (if you use one)
If the employee is an apprentice please enter the apprenticeship end date
Hourly rate (for pension rate calculation)
Hours per week this employee will work (or FT if fulltime, ad-hoc if occasional)
If not full-time, how many hours does a full-timer work in your organisation?
If the employee is a GP please supply pension rate
Please indicate if this person is a director
Yes
No
Employee contributions (Non-NHS pension)
Employer contributions (Non-NHS pension)
Start date
days from now
Holiday fund percentage (if required)
Starter tax form (please ensure you have at least a Starter Checklist before the first payroll). Please DO NOT accept a P38(S)
P45 available now (please complete P45 and Starter Checklist sections below)
P45 not provided (please complete Starter Checklist sections below)
P45 leaving date
P45 tax code
P45 Month 1 ticked?
Yes
No
P45 student loan?
Yes
No
P45 Enter week or month last paid (Please put W or M and number)
P45 pay to date
P45 tax to date
A
B
C
Starter Checklist box ticked (see the statement choices on the Checklist
Starter Checklist student loan paid through payroll
Yes
No
Starter Checklist Postgraduate loan payable through payroll
Yes
No
Plan 1
Plan 2
Starter Checklist Student Loan Plan (post 6th April 2016 only). If the employee genuinely doesn't know, use Plan 1
Bank sort code (for staff with automated bank submission)
Bank account (for staff with automated bank submission)
Building soc ref (for staff with automated bank submission)
Leaving date
days from now
Comments - please supply any additional information. For changes of name or address please supply the old value
Please add anything here to help clarify your form. PLEASE DO NOT tell us that an employee doesn't wish to join a pension scheme. They will be assessed for auto enrolment, and can opt out once they have joined.
Form completed by
Completion date