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PA TO COMPLETE

To be completed and signed by the employee, all details will be treated as confidential.

Employee Personal Details

Name(Required)
Date of Birth:(Required)
If you are over state retirement age please provide proof of age (Copy of birth certificate, passport, driving license or NI Exemption certificate). If you do not provide evidence of your age we cannot ensure that the correct National Insurance category is applied to you and you may pay unnecessary NI contributions in this employment. Please ensure you only send a copy and not the original documents.
Address(Required)

Contact Details

I have read and understood how my data will be used and processed as a third-party data in line with the privacy notice and I declare that the information given above is true and accurate:
Clear Signature
Print Name:(Required)
Date(Required)

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