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Payment Details

NI Number *

Bank / Building Society Name

Bank / Building Society Address *

Account in the name of *

Account Number *

Sort Code *

P45 Enclosed
Yes No

P46 Required
Yes No

Ltd Company Details (if applicable)

Company Name

Account Name

Account Number

Sort Code

Company Number

VAT Number

Self billing *

Self Employed Details (if applicable)

UTR Number *

VAT Number (if applicable) *

Self billing *

Public Liability Insurance enclosed *

Self Employed Declaration

I believe that I am liable to “Self Employed” status and that as a result you will not deduct Income Tax and Class One National Insurance from my remuneration. I confirm that I will submit Schedule D “Self Employed” accounts to HM Revenue & Customs through the self assessment tax system. I have submitted/will submit within three months of completing this form, the CWF1 form to HM Revenue & Customs.

My Schedule D/self assessment reference is

My local tax office is

Telephone

My Accountant / Tax Advisors are

Name / Address

Telephone

I confirm that I will indemnify Athona for unpaid Income Tax and National Insurance in the event that HM Revenue & Customs disallow my schedule D tax status and determine, at any one time, my status as an employee. You have advised me to seek independent financial/tax advice and that cannot in any way be held liable to any misinterpretation of the tax legislation relating to my self employed status

Name *

Start Date: *

signature

Ltd Company Details (if applicable)

Self Employed Details (if applicable)

Self Employed Declaration

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