Your Details Name Date Of Birth Contact Number Email Address House Number Address Line 1 Address Line 2 City/Town Post Code National Insurance Number Acknowledgement Acknowledgement I confirm the above details are correct Are you a member of the Unite Union? Are you a member of the Unite Union? Yes No Acknowledgement Acknowledgement I confirm the above details are correct Current Tax Code Current Employer Employment start date? Job description Time with employer Industry? Acknowledgement Acknowledgement I confirm the above details are correct Please note the date of any claims of Job Seekers Allowance/Universal Credit: Former employer name? Employment start date Time in employment Job description Industry? Have you received a Tax Refund in the past 4 years? Have you received a Tax Refund in the past 4 years? Yes No Have you received a notification from HMRC that you have unpaid Tax due to them? Have you received a notification from HMRC that you have unpaid Tax due to them? Yes No Do you wear a logo'd uniform? Do you wear a logo'd uniform? Yes No Do you cover business mileage in your own vehicle? Do you cover business mileage in your own vehicle? Yes No Do you buy your own tools and equipment? Do you buy your own tools and equipment? Yes No Do you have receipts? Do you have receipts? Yes No Please state the total amount spent on additional items: Amount to claim - Prior Year 1 Amount to claim - Prior Year 2 Amount to claim - Prior Year 3 Amount to claim - Prior Year 4 Acknowledgement Acknowledgement I confirm the above details are correct Do you have to purchase any sector specific / protective clothing? Do you have to purchase any sector specific / protective clothing? Yes No Do you have receipts? Do you have receipts? Yes No Acknowledgement Acknowledgement I confirm the above details are correct Do you pay any professional subscriptions? Do you pay any professional subscriptions? Yes No Which professional body do you pay these to? Amount to claim - Prior Year 1 Amount to claim - Prior Year 2 Amount to claim - Prior Year 3 Amount to claim - Prior Year 4 Total amount to claim: Acknowledgement Acknowledgement I confirm the above details are correct Have you paid any course fee's during employment? Have you paid any course fee's during employment? Yes No Have you paid for any medical examinations? Have you paid for any medical examinations? Yes No How much did you have to pay? On what date did you pay this? Acknowledgement Acknowledgement I confirm the above details are correct Have you had to pay for any vaccinations / and or visas? Have you had to pay for any vaccinations / and or visas? Yes No Have you paid for a security license during employment? Have you paid for a security license during employment? Yes No Any other notes? Acknowledgement Acknowledgement I confirm the above details are correct Submit
