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Employee's details in CAPITALS | ||||||||||||||||||||||||||||||
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Please
keep this form for at least 3 years after the end of the year to which it relates, or longer if you are asked to do so. |
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National Insurance contributions | Note: LEL = Lower Earnings Limit, UEL = Upper Earnings Limit | Statutory payments | ||||||||||||||
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For Employers use |
Earnings details | Contribution details | Student Loan |
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Earnings at the LEL (where earnings are equal to or exceed the LEL) |
Earnings above the LEL, up to and including the Earnings Threshold |
Earnings above the Earnings Threshold, up to and including the UEL |
Total
of employee's and employers contributions - Marks minus amounts 'R' |
Employee's contributions due on all earnings above the ET |
Statutory
Sick Pay (SSP) Paid to employee in the week or month included in column 2 |
Statuory
Maternity Pay (SMP) paid to employee in the week or month included in column 2 |
Statutory
Paternity Pay (SPP) paid to employee in the week or month included in column 2 |
Statuory
Adoption Pay (SAP) paid to employee in the week or month included in column 2 |
Deductions | |||||||
1a £ | 1b £ | 1c £ | 1d £ p | 1e £ p | 1f £ p | 1g £ p | 1h £ p | 1i £ p | 1j £ | |||||||
1 |
1 |
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2 |
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3 |
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4 |
4,004 | 611.00 | 7,385.00 | 1,757.63 | 812.35 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
2 |
5 |
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6 |
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7 |
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8 |
0 | 0.00 | 6,313.33 | 1,735.33 | 711.33 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
3 |
9 |
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10 |
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11 |
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12 |
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13 |
0 | 0.00 | 6,313.33 | 1,735.33 | 711.33 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
4 |
14 |
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15 |
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16 |
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17 |
0 | 0.00 | 6,313.33 | 1,735.33 | 711.33 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
5 |
18 |
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19 |
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20 |
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21 |
0 | 0.00 | 0.00 | 1,656.00 | 120.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
6 |
22 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | |||||
23 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
24 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
25 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
26 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
7 |
27 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | |||||
28 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
29 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
30 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
8 |
31 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | |||||
32 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
33 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
34 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
35 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
9 |
36 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | |||||
37 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
38 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
39 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
10 |
40 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | |||||
41 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
42 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
43 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
11 |
44 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | |||||
45 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
46 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
47 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
12 |
48 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | |||||
49 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
50 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
51 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
52 |
0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
§  |
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Total | 4,004 | 611.00 | 26,324.99 | 8,619.62 | 3,066.34 | 0.00 | 0.00 | 0.00 | 0.00 | 0 | ||||||
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End of Year Summary | Scheme Contracted-out Number | ||||||||||||||||||
Enter N I Contribution | (For
Contracted-out Money Purchase schemes OR Contracted-out Money Purchase Stakeholder Pension schemes only) |
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Table Letter here
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If amended cross out previous code |
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PAYE Income Tax and Tax Credits | ||||||||||||||||
K codes only | K codes only | K codes only | ||||||||||||||
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Pay in the week or month including Statutory Sick Pay/ Statutory Maternity Pay |
Total pay to date |
Total free pay to date * |
Total additional pay to date (Table A) |
Total taxable pay to date i.e. column 3 minus column 4a or column 3 plus column 4b * |
Total tax due to date as shown by Taxable Pay Tables |
Tax due at end of current period Mark refunds R |
Regulatory limit i.e. 50% of column 2 entry |
Tax deducted or refunded in the week or month Mark refunds R |
Tax not deducted owing to the Regulatory limit |
Tax Credits |
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2 £ p | 2 £ p | 4a £ p | 4b £ p | 5 £ p | 6 £ p | 6a £ p | 6b £ p | 7 £ p | 8 £ p | 9 £ p | ||||||
1 | 1 | |||||||||||||||
2 | ||||||||||||||||
3 | ||||||||||||||||
4 | 12,000.00 | 12,000.00 | 384.92 | 11,615.08 | 4,178.29 | 4,178.29 | 0.00 | |||||||||
2 | 5 | |||||||||||||||
6 | ||||||||||||||||
7 | ||||||||||||||||
8 | 0.00 | 12,000.00 | 0.00 | 12,000.00 | 4,178.29 | 0.00 | 0.00 | |||||||||
3 | 9 | |||||||||||||||
10 | ||||||||||||||||
11 | ||||||||||||||||
12 | ||||||||||||||||
13 | 0.00 | 12,000.00 | 0.00 | 12,000.00 | 4,178.29 | 0.00 | 0.00 | |||||||||
4 | 14 | |||||||||||||||
15 | ||||||||||||||||
16 | ||||||||||||||||
17 | 24,000.00 | 36,000.00 | 1,539.68 | 34,460.32 | 11,913.19 | 7,734.90 | 0.00 | |||||||||
5 | 18 | |||||||||||||||
19 | ||||||||||||||||
20 | ||||||||||||||||
21 | 12,000.00 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
6 | 22 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
23 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
24 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
25 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
26 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
7 | 27 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
28 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
29 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
30 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
8 | 31 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
32 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
33 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
34 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
35 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
9 | 36 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
37 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
38 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
39 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
10 | 40 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
41 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
42 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
43 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
11 | 44 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
45 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
46 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
47 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
12 | 48 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | |||||||||
49 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
50 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
51 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
52 | 48,000.00 | 1,924.60 | 46,075.40 | 16,044.49 | 4,067.30 | 0.00 | ||||||||||
§  | ||||||||||||||||
*If in any week/month
the amount in column 4a is more than the amount in column 3, leave column 5 blank. |
Pay | Tax Deducted | Employee's | Tax Credits | |||||||||
3 £ p | Pay and Tax totals | 6 £ p | Widows & Orphans/ Life Assurance |
in this | ||||||||
0.00 | ![]() |
In previous employments | ![]() |
0.00 |
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contributions in this employment |
employment 9 £ p |
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48,000.00 | ![]() |
In this employment Mark net refund 'R' |
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16,044.49 | ![]() |
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0.00
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48,000.00 | ![]() |
Total for year | ![]() |
16,044.49 |