New starter declaration

Your employer uses Independent Lives services to help manage their care.

They have asked us to collect some details which will allow them to pay your wages. Please note that failure to complete this form may result in delays processes your wages.

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Banking User Status

Name of the person receiving care

First Last

Your details

What is your name?(Required)

Your email address(Required)

What is your date of birth?(Required)

What is your sex?(Required)

As shown on your passport or gender recognition certificate.

Male

Femaie

What is your National Insurance Number?(Required)

What is your postal address?(Required)

Street Address Address Line 2 City Postcode

Your present circumstances

Read all the following statements carefully and select the option that applies to you.

A: This is your first job since 6 April of the current tax year. You have not received any taxable benefits such as Jobseeker’s Allowance, Employment and Support Allowance, or taxable Incapacity Benefit since 6 April.

B: You have had

another job since 6 April which has now ended. And/or you have received taxable benefits such as Jobseeker’s Allowance, Employment and Support Allowance, or taxable Incapacity Benefit since 6 April.

C: You currently have another job. And/or you are receiving a state, workplace, or private pension.

Student loans

Have you left a course of Higher Education since 6 April, received your first Student Loan instalment on or after 1 September 1998, and not fully repaid your Student Loan?(Required)

Yes

If you are required to repay your Student Loan through your bank or building society account, select “No.”

Bank details for payment of wages

Please provide the following information so we can pay your wages directly into your bank account:

Account holder's name(Required)

Sort code(Required)

Account number(Required)

Privacy

I have read and agree to Independent Lives privacy policy(Required)

I agree to the privacy policy