WP E-Signature by Approve Me - Sign Documents Using WordPress -

New Starter Declaration Form

Starter Checklist

Tell your employer of your circumstances so
that you do not pay too much or too little tax

Do not send this form to HM Revenue and Customs (HMRC)

Instructions for employers

Use this starter checklist to gather information about your new employee if they do not have a P45. You can also
use this form if they have a student loan (whether or not they have a P45). Use the information to help fill in your first Full
Payment Submission (FPS) for this employee. If you have already submitted your first FPS, keep using the tax code in that
FPS until HMRC sends you a new tax code. If the employee gives you their P45 after the first FPS submission, use the tax
code shown in parts 2 and 3 of the P45. You must keep the information recorded on the starter checklist for the current
and next 3 tax years. This form is for your use only.

Instructions for employee

Fill in this form if you do not have a P45 (a document you get from your employer when you stop working for them).
You should also fill in this form if you have a student loan (whether or not you’ve a P45). Give the completed form to your
employer as soon as possible. They need this information to tell HMRC about you and help them to use the right tax code.
Make sure you answer the questions correctly. If you do not, you may pay the wrong amount of tax or student loan deductions.

Employee's Personal Details

1. Last Name:

2. First Names
Do not enter initials or shortened names such as Jim for James or Liz for Elizabeth

3. What is your sex?
As shown on your birth certificate or gender recognition certificate

Male Female

4. Date of Birth DD MM YYYY

/ /

5. Home Address

, , ,

6. National Insurance Number if Known

7. Employment Start Date DD MM YYYY

/ /

Continue on the next page

Starter checklist

Page 1

HMRC 09/22

Employee Statement

These questions will help you to choose the statement that matches your circumstances. The statement you choose helps
your employer to apply the correct tax code.

8. Do you have another job?

Yes (Put an ‘X’ in the statement C box below)

No (Go to question 9)

9. Do you receive payments from a State, workplace or private pension?

Yes (Put an ‘X’ in the statement C box below)

No (Go to question 10)

10. Since 6 April have you received payments from:

• another job which has ended
or any of the following taxable benefits
• Jobseeker’s Allowance (JSA)
• Employment and Support Allowance (ESA)
• Incapacity Benefit

Yes (Put an ‘X’ in the statement B box below)

No (Put an ‘X’ in the statement A box below)

For more information about tax codes, go to www.gov.uk/tax-codes

Statement A . (where: . . . . . . . . . . . . . .) Statement B . (where: . . . . . . . . . . . . . . . . .) Statement C . (where: . . . . . . . . . . . . .)

Current personal allowance	Current personal allowance on a Week 1/Month 1 basis	Tax Code BR
Key This is my first job since 6 April and since the 6 April I have not received payments from any of the following: Jobseeker’s Allowance Employment and Support Allowance Incapacity Benefit	Key Since 6 April I have had another job but I do not have a P45. And/or since the 6 April I have received payments from any of the following: Jobseeker’s Allowance Employment and Support Allowance Incapacity Benefit	Key I have another job and/or I am in receipt of a State, workplace or private pension.

Current personal allowance

Current personal allowance
on a Week 1/Month 1 basis

Tax Code BR

Key

This is my first job since 6 April and
since the 6 April I have not received
payments from any of the following:

Jobseeker’s Allowance
Employment and Support Allowance
Incapacity Benefit

Key

Since 6 April I have had another job but I do
not have a P45. And/or since the 6 April I have
received payments from any of the following:

Jobseeker’s Allowance
Employment and Support Allowance
Incapacity Benefit

Key

I have another job and/or I am in receipt
of a State, workplace or private pension.

Key

Jobseeker’s Allowance (JSA) is an unemployment benefit which can be claimed while looking for work. Employment and Support Allowance (ESA) is a benefit which can be claimed if you have a disability or health condition that affects how much you can work. Incapacity Benefit is help if you could not work because of an illness or disability before 31 January 2011. State Pension is a pension paid when you reach State Pension age. Workplace pension is a pension which was arranged by your employer and is being paid to you. Private pension is a pension arranged by you and is being paid to you. Please note that no other Government or HMRC paid benefits need to be considered when completing this form.

Continue on the next page

Page 2

Student loans

11. Do you have a student or postgraduate loan?

Yes (Go to question 12)

No (Go straight to the Declaration)

12. Do any of the following statements apply:

• you’re still studying on a course that your
student loan relates to
• you completed or left your course after the
start of the current tax year, which started
on 6 April
• you’ve already repaid your loan in full
• you’re paying the Student Loans Company
by Direct Debit from your bank to manage
your end of loan repayments

Yes (Go straight to the Declaration)

No (Go to question 13)

13. To avoid repaying more than you need to, tick the
correct student loan or loans that you have – use the
guidance on the right to help you.

Please tick all that apply

Plan 1

Plan 2

Plan 4

Postgraduate loan (England and Wales only)

Employees, for more information about the type of
loan you have or to check your balance, go to
www.gov.uk/sign-in-to-manage-your-student-loan-balance
Employers, for guidance on student loans and which plan or loan
type to use if your employee has selected more than one,
go to www.gov.uk/guidance/special-rules-for-student-loans

You have Plan 1 if any of the following apply:

• you lived in Northern Ireland when you started
your course
• you lived in England or Wales and started your course
before 1 September 2012

You have a Plan 2 if:
You lived in England or Wales and started your course on or after 1 September 2012.

You have a Plan 4 if:
You lived in Scotland and applied through the Students Award Agency Scotland (SAAS) when you started
your course.

You have a Postgraduate Loan if any of the
following apply:

• you lived in England and started your postgraduate
master’s course on or after 1 August 2016
• you lived in Wales and started your postgraduate
master’s course on or after 1 August 2017
• you lived in England or Wales and started your
postgraduate doctoral course on or after 1 August 2018

Give this form to your employer

Your employer will use the information to make sure you pay the right amount of tax.
Do not send this form to HMRC.

Employer guidance

For information on how to work out your new employee’s tax code, go to www.gov.uk/new-employee-tax-code
Use Statement A, B or C that your employee has chosen in the employee statement section and apply the tax code below:
• Statement A – use the current personal allowance
• Statement B – use the current personal allowance on a ‘week 1/month 1’ basis
• Statement C – use tax code BR