| Employer name                                                                                                                               | EP Appendix 7B PAYE reference            |
|---------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------|
| Declaration                                                                                                                                 |                                          |
| In accordance with Part 1, EP Appendix 7B, I can confirm that this NICs Settlement Return only applies to those employees who:              |                                          |
| 1.are employed by a UK employer assigned to work abroad for a limited duration, but for more than a complete tax year                       | No                                       |
| 2.have an ongoing liability to UK NICs whilst abroad                                                                                        | No                                       |
| 3.earn above the upper earnings limit in every earnings period throughout the tax year                                                      | No                                       |
| 4.are not resident and ordinarily resident for tax purposes and not liable to UK tax on their earnings from their employment                | No                                       |
| 5.receive some earnings and benefits derived from the employment from sources other than the UK employer.                                   | No                                       |
| Repayment                                                                                                                                   |                                          |
| Where this return indicates that a repayment of NICs is due, I confirm that I have read and applied the guidance at Part 9, EP Appendix 7B. | No                                       |
| A                                                                                                                                           | B                                        |
| F                                                                                                                                           |                                          |
| Employee                                                                                                                                    | NI                                       |
| NICs paid under PAYE and shown on the P35                                                                                                   | Final details of earnings liable to NICs |
| Social                                                                                                                                      | Additional                               |
| Total                                                                                                                                       |                                          |
| name                                                                                                                                        | number                                   |
| P14                                                                                                                                         |                                          |
| security                                                                                                                                    | Class 1 primary                          |
| settlement                                                                                                                                  |                                          |
| P14                                                                                                                                         | P14                                      |
| Actual                                                                                                                                      | Actual                                   |
| equalised                                                                                                                                   | NICs reported as                         |
| Class 1                                                                                                                                     | Class 1                                  |
| additional                                                                                                                                  | Class 1                                  |
| earnings in year                                                                                                                            | NICs                                     |
| primary                                                                                                                                     | primary                                  |
| Class 1                                                                                                                                     | secondary                                |
| of payment                                                                                                                                  |                                          |
| NICs to UEL                                                                                                                                 | NICs over                                |
| primary NICs                                                                                                                                | NIC s                                    |
| the UEL                                                                                                                                     |                                          |
| on earnings                                                                                                                                 |                                          |
| (Y/N)                                                                                                                                       |                                          |
| over UEL                                                                                                                                    |                                          |
| (H + J) - (D + E)                                                                                                                           | K - F                                    |