ࡱ> uwtc bjbj =b؎U\؎U\>>>>>8,5(-5/5/5/5/5/5/5$7:5>5>>5>>-5-523%:6255052::(3:>3<S5S55:> : If you consider yourself to be self-employed in your role with the University this declaration must be completed by you for the School or department for whom you are providing services and then countersigned by the School or Department. The nature of each contractual arrangement is determined by the terms and conditions agreed for its performance. There is no discretion available to either the University or you to choose the employment status (i.e. self-employment or employment) that will be applied. Note it is possible that although you may be self-employed on other employments, the terms of the arrangement entered into with University may be such that you will be treated as an employee of ֲý. Naturally, the opposite may also apply. Once you have completed and signed this declaration you must return it to the School or Department for whom you are providing services, along with any supporting documentation you wish to provide. The declaration will then be reviewed internally and, in some cases, submitted to HM Revenue & Customs for their ruling as to which employment status is to be applied. Status Claimed 1Are you claiming self-employed status?YES / NO Contract Terms 2Are you trading as a: limited company partnership sole trader(please tick one option) ( ( (3Please provide your NI Number Schedule D/UTR number VAT Number (if registered) Limited Company Number (if applicable)  4The terms and conditions agreed are determined by what type of agreement A written tender A written contract A verbal contract (A copy of any written agreement must be attached)5If there is no written contract describe here the key terms of the verbal contract agreed  6On what date will the arrangement start? On what date will the arrangement end?. ..7How are you to be paid? By invoice By salary If you are paid by invoice are you paid a set fee or an hourly/daily rate? 8Has HWU employed you on PAYE employment terms within 12 months of the last year end (31st March)?9Do you receive any benefits in addition to the contractual payment? Such as: Holiday pay Sick pay Other benefits (cash or non-cash)  Work Undertaken 10What is the nature of the duties to be performed? Teaching Research Other (describe below) Subject . Project . ...11Are you required to perform the duties themselves or are you at liberty to appoint a substitute or stand-in? 12If a substitute or stand-in is appointed who is responsible for paying them? 13Have you employed anyone in the last 24 months to undertake work you have taken on? Management & Control 14Who sets the work that you have to undertake on a day to day basis? 15Who sets the hours that you have to work? What are those hours?16How is the work performed supervised / monitored by the University?17To whom are you ultimately responsible? 18If the work is not performed to a satisfactory standard do you have to put it right at your own expense?19Do you provide all of your own facilities and equipment to perform your duties? If no, what facilities and/or equipment does the University provide? Office space Administrative support University phone & e-mail Research equipment Tool of the trade20Where is the work to be performed? (Please state the location). Who determines this? 21If attending meetings, who will you be representing?22What rules and regulations are you required to adhere to while carrying out your duties? (i.e. financial regulations, HR policies, etc)23Do you have Professional Indemnity Insurance? Name of applicant . Signature of applicant Date. ֲý Use Only Financial Controller Financial Controller Signature . Date .      Self Employment Declaration Form PS2 Page  PAGE 4 ( NUMPAGES 4) c % ( ) ? 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