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ISLE OF WIGHT COUNCIL HOUSING / COUNCIL TAX BENEFIT EMPLOYERS CERTIFICATE OF EARNINGS

Isle of Wight Council

	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

PRIVATE & CONFIDENTIAL

Claim No:

	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 REVENUE SERVICES DIVISION, COUNCIL OFFICES, BROADWAY, SANDOWN, ISLE OF WIGHT PO36 9EA
	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
	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

	Pay Details
	Please complete ALL the boxes below with details of this employee's last 5 weeks / 2 months pay.

Week/ Month ended	/ /	/ /	/ /	/ /	/ /
Gross Pay	�	�	�	�	�
Income Tax	�	�	�	�	�
National Insurance	�	�	�	�	�
Private Pension Superannuation	�	�	�	�	�
NET PAY	�	�	�	�	�
TAX YEAR - TOTALS TO DATE	�	�	�	�	�

Does your employee receive any tips, commission, bonuses or overtime?

Yes

If yes, please give details.

	AT WEEK / MONTH No.
*	Date of last pay rise	/ /

If this employee has not been in your employment for the full 5 week / 2 month period please give details of their terms of employment:-

Frequency of pay

WEEKLY 4 WEEKLY CALENDAR MONTHLY

GROSS PAY �

and the date of the first payment

/ /

	The employer is requested to sign this form and authenticate it by the company official stamp in the box below.
	Employers Details:

*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street address
*	Town name
	County
*	Postcode
	Tel number (include area code)
	Email address
	Fax

Company stamp

	Signed............................................................... Name................................................................ Date.................................................................. Position in Company...........................................
	Please reply to:- REVENUE SERVICES DIVISION, COUNCIL OFFICES, BROADWAY SANDOWN, ISLE OF WIGHT PO36 9EA Tel: (01983) 823950

LOCAL OFFICES FOR BENEFIT ENQUIRIES

	To hand your benefit form in personally, to have your evidence and proofs copied and for all benefit and council tax enquiries, please visit one of the offices listed below.
	Please send all postal communications to the Council Offices, Sandown.
	We experience high volumes of customers between 12 - 2. If you could visit us at another time of the day it would be appreciated.

Council Offices Broadway Sandown Isle of Wight PO36 9EA 01983 823950	08.30 - 17.00 08.30 - 16.30 Late night for phone calls to the Benefit Section on Wednesday evening until 6:00pm	Monday - Thursday Friday
Customer Service Centre County Hall High Street Newport PO30 1UD	08.30 - 17.00 08.30 - 16.30	Monday - Thursday Friday
Ryde Help Centre Ryde Library 101 George Street Ryde PO33 2JE	09.00 - 17.00 09.00 - 17.00	Monday - Wednesday Friday
Freshwater Library 41 School Green Road Freshwater PO40 9AP	09.30 - 13.30 14.00 - 17.15 09.30 - 13.30 14.00 - 16.45	-This service has temporarily been suspended on FRIDAYS- Tuesday Friday
Ventnor Coastal Centre Dudley Road Ventnor PO38 1EJ	09.00 - 12.00	Thursday
Cowes Library 12-14 Beckford Road Cowes PO31 7SG	13:00 - 16:00	---This service has temporarily been suspended--- Wednesday
East Cowes Library 11 York Avenue East Cowes PO32 6QY	09.00 - 12.00	---This service has temporarily been suspended--- Wednesday
Wootton Help Centre 4/5 Joannes Walk Brannon Way Wootton Bridge PO33 4NX	09.00 - 13.00 09.00 - 13.00	---This service has temporarily been suspended--- Monday Friday

Data Protection Act 1998

This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request.

The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest.

Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law.

Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box

To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 08/03/2013