For office use only:
SAP No.
Start date:
PSU contact:
Bank details form
This form can be used by new employees notifying the relevant details in all sections
or by existing employees who need to update their bank details only.
The form can be completed electronically or manually. Either way, the declaration
must be signed by hand.
Employee details
Title and full name
Job title
Department
Select from list...
Service name or School name
National Insurance number
Date of birth
Personnel number (if known)
If you do not have a National Insurance Number please contact your local Jobcentre
Plus office on 0845 600 0643 or visit www.gov.uk/national-insurance
Bank or building society details
The account must be held in your name. For joint accounts, yours must be one of
the names listed.
Name of bank / building
society
Branch address
Sort code
Account number
Roll number
(building society only)
Student loans
Do not complete this section if you are already repaying your student loan directly from your
bank or building society.
I left a course of UK Higher Education before last 6 April and received my first UK
Student Loan instalment on or after 1 September 1998 and have not fully repaid my
Student Loan. If this statement applies please select from the options below:
I lived in Scotland or Northern Ireland when I started my course OR
I lived in England or Wales and started my course before September 2012
I lived in England or Wales and started my course after 1 September 2012
Plan 1
Plan 2
Page 1 of 3
National Insurance (NI) contributions
Without evidence of specific eligibility, you will pay full NI contribution rates.
I am eligible to pay reduced NI contributions. Evidence is enclosed or will
be forwarded as soon as my previous employer provides it.
I no longer pay NI contributions as I have reached state pension age.
Evidence is enclosed or has been verified during my recruitment process.
Neither of these apply to me
Income tax
Select the one option which applies to you.
I have been in
taxable employment
since last 6 April and
enclose my P45 certificate.
will send my P45 to the payroll office as soon as
my previous employer issues it to me.
this is my first job since then and I have not been
receiving taxable Jobseeker’s Allowance,
Employment Support Allowance or taxable
Incapacity Benefit, state pension or occupational
pension.
(A)
I have not been in
taxable employment
since last 6 April and
this is now my only job, but since last 6 April I
have received taxable Jobseeker’s Allowance,
Employment Support Allowance or taxable
Incapacity Benefit. I do not receive a state
pension or occupational pension.
(B)
I have another job and/or receive a state pension
and/or occupational pension.
(C)
Statutory Sick Pay (SSP) for Welfare To Work programme
If you are returning to work under the Welfare to Work Programme then you will
have been given a letter by Jobcentre Plus which should be passed to your
employer. This letter should confirm that if you fall sick within 12 weeks of your last
day of entitlement to benefit then you will be excluded from any entitlement under
the Statutory Sick Pay scheme. During the exclusion period stated, you may be
entitled to recommence your Employment Support Allowance.
This applies to me and my letter is enclosed
Declaration
I declare the above details to be accurate and complete. I understand that it is my
responsibility to ensure that the details on this form are correct and that providing
inaccurate information may delay payment of my salary.
Signed
Date
Note: for audit purposes this form must be signed by hand.
Completed forms should be returned to the Personnel Support Unit at County Hall.
Page 2 of 3
Give As You Earn (GAYE) scheme
The County Council runs a GAYE charity giving scheme through the Charities Aid
Foundation (CAF). The scheme allows staff to donate to charities directly from their
pre-tax salary. You can find out more by visiting www.cafonline.org
If you wish to make a donation, complete the form below and it will be forwarded to
CAF on your behalf. Donations can be ceased or amended at any time by contacting
the payroll office [email protected]
Employee details
Title and full name
Employee payroll number
Home address
Email address
Telephone number
Name of employer
National Insurance number
Donation type
Charity details
Date of birth
Select from list...
Charity 1
Charity 2
Charity name
Business address
Commission number
leave blank if unknown
leave blank if unknown
Sponsorship number
leave blank if unknown
leave blank if unknown
Value of monthly
donation
Declaration
Signed
Date