HM Revenue H & Customs Starter checklist Instructions for employers This Starter Checklist can be used to gather information about your new employee. You can use this information to help fill in your fist Full Payment Submission (FP) for this emplayce. You need to keep the information recorded on the Starter Checklist record forthe current and previous thvee tax years. Do not send this form to HM Revenue and Customs (HMARC) Instructions for employees ‘As a new employee your employer needs the information on this form before your first payday to tell HMRC about you and help them use the correct tax coe. Flin ths form then give it to your employer. Do not send this form to HMRC. Employee's personal details [73) tase mame [73] Home adress 2] First name(s) o not enter initials or shortened names such as Jim for — James or Li for Elizabeth Poscoce counry [7a] national isurance number (Fo¥n) OO 00 OO Ooo Employment start date 0D MM YYVY [3] Are you mate or female? Mate Femate L_] (a) bate of birth 0 sam very Gi 0000 DO OOo Employee statement [-) You need to setect only one of the following statements A, B or ¢ A This is my first job since last 6 April and | have not been receiving taxable Jobseekers J Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State oF Occupational Pension. B This fs now my only job but since last 6 April have had anotier job, or received taxable ‘J Jobseekers Allowance, Employment and Support Allowance oF taxable Incapacity Benefit | do not receive a State or Occupational Pension, c¢ [] Aswell as my new job, ! have another job or receive a State or Occupational Pension Please turn over > Starter checklist Page 1 omc 04/16Student Loan {73} 0 you have a Student Loan which is not fully repaid? Yes J Hfyes. go to question 10 No. Ino, goto question 12 |] Are you repaying your student Loan direc tothe Student Loans Company by agreed monthly payments? ves «| tyes goto question 12 wo (] ne, got question 11 Student Loan Plans You will have a Plan 1 Student Loan if + You lived in Scotland or Northern treland when you started ‘your course, or + You lived in England or Wiles and started your course before September 2012 You will have a Plan 2 Student Loan if you lived in England or ‘Wales and started your course on or after | September 2032. [LD What type of student Loan do you have? m Plan) L5. Plan 2 [72] did you finish your studies before the last 6 April? C] w [J For further guidance about repaying Student Loans go to ‘wove gov.uk/new-employee/student-loans Yes Signature ‘Nome Date 0D MM YYYY O10 00 00000 Page 2