All fields marked with a * are required entries
EMPLOYERS CERTIFICATE OF EARNINGS
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Isle of Wight Council Housing / Council Tax Benefit Employers Certificate Of Earnings
Completed application forms should be returned to:
Isle of Wight Council, Council Offices,
Sandown, Isle of Wight
PO36 9EA
Claim Number
DO NOT COMPLETE THE PAY DETAILS YOURSELF - PLEASE ASK YOUR EMPLOYER TO COMPLETE THIS
This form should only be completed if you do not have pay slips or you receive handwritten pay slips.
Please enter on this form your name, address and occupation and pass it to your employer to complete the remaining information required.
Please ensure this form is returned to the address below.
PLEASE NOTE:- If both you and your partner are in employment you must both get your employer to complete a Certificate of Earnings. Please contact the Revenue Services Division if you need more than one Certificate of Earnings.
Applicants Details
*
Forename
Middle name/Initials
*
Surname
*
National Insurance Number
*
Occupation
Applicants Employment Details
*
Date employment commenced
----
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
---
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Nov
Dec
Month
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
*
How many hours a week do you usually work?
*
How often is your employee paid?
Weekly
4 Weekly
Calendar Monthly
*
How is your employee paid?
Cash
Cheque
Direct to Bank Account
Fields marked '*' are required entries.
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