NCS PAYE Form

Employee Section:
It is the responsibility of the employee to indicate what period they wish to be assessed on. Please
indicate which period you wish to be assessed on:

Please indicate which period you wish to be assessed on.

If you are being assessed on last year the period should be 01/01/2020 to 31/12/2020

If you are being assessed from the beginning of the year the period should be 01/01/2021 to last Sunday.

If you are being assessed on the last four weeks the period should be the four weeks up to last Sunday,
i.e. Monday of week 1 to Sunday of week 4.

Assessment Period Start Date Assessment Period End Date

DD/MM/YYYY DD/MM/YYYY
Employer Section:
Employee’s Name:
Employee’s PPSN:
Employer/Company Name:
Employer Address:

Please provide the following figures for the above named employee, covering only the Assessment
Period as indicated above.

Employee’s Gross Pay for Tax/PAYE in period €

Total Net Tax Deducted in period €

PRSI contributions paid by Employee in period €

Total USC paid for this employment in period €

Joint Section:

I declare that the above information is true and accurate to the best of my knowledge

Employee Signature: Date: DD/MM/YYYY

Employer Signature: Date: DD/MM/YYYY

Please Note: Forms that are not signed and stamped by all parties will not be accepted by Pobal. This will
result in processing delays.