Fillable Printable National Insurance Form Sample
Fillable Printable National Insurance Form Sample
National Insurance Form Sample
Your%National%Insurance%number
About%this%form When%to%complete%this%form
Use*this*form*to: Complete*this*form*if*you:
•* request*written*confirmation*of*your*National*Insurance* •* have*a*NINO*and*need*us*to*confirm*it*in*writing*because*you*
number*(NINO)*and/or have*been*unable*to*request*it*by*phone
•* tell*us*about*a*change*to*your*personal*details. •* have*recently*received*notification*of*your*NINO*and*need*to*
update*your*personal*details
Where%to%find%your%NINO
•* have*been*told*to*by*an*advisor*on*one*of*the*National*
If*you*do*not*know*your*NINO*you*might*be*able*to*find*it*on*
Insurance*Helplines.
official*paperwork*such*as:*
•* your*form*P60*End$of$Year$Certificate,*given*to*you*by*
When%not%to%complete%this%form
your*employer
Do*not*complete*this*form*if*you:
•* a*payslip
•**have*never*had*a*NINO*before*and*are*under*age*20.*
•* a*copy*of*your*annual*Self*Assessment*tax*return
Phone*the*National*Insurance*Registrations*Helpline*on%
•* other*official*correspondence*from*HM*Revenue*&*Customs*
0845%915%7006*for*advice
•**have*never*had*a*NINO*before*and*are*over*age*20.*Phone*
(HMRC).
Jobcentre*Plus*on*0845%600%0643%for*advice*or*go*to*
Written%confirmation%of%your%NINO
www.direct.gov.uk%
If*you*need*written*confirmation*of*your*NINO*you*don't*have*to*
•* want*a*letter*in*Welsh*confirming*your*NINO,*please*phone*
fill*in*this*form*to*get*this*information*from*us.*You*can,*if*you*
0845%302%1489*and*ask*for*form*CA5403W.
want,*phone*our*National*Insurance*Registrations*Helpline*on*
0845%915%7006*and*they*will*arrange*to*send*confirmation*to*
What%to%do%next
If,*after*considering*all*of*the*information*above,*you*still**
you.*If*you*live*outside*the*UK,*phone*
want*to:
+44%191%203%7010.
•* request*written*confirmation*of*your*NINO*and/or
Please%note%a%letter%confirming%your%NINO%cannot,%on%its%
•* tell*us*about*a*change*in*your*personal*details
own,%be%used%to%prove%your%identity.%
complete*this*form.*Make*sure*you*read*and*sign*the*
Declaration*on*page*2.*
Please*use*capital*letters*and*write*clearly*in*black*ink.*
***Indicates*required*field.
Please*turn*over*>>>
CA5403 PAGE*1* HMRC*10/13
PAGE*2*
Your%details
Title*–*$for$example$Mrs,$Miss,$Ms,$Mr,$Dr,$Rev$*
Surname**
First*names***
Previous*surname*if$applicable
Previous*first*names*if$applicable
Gender*Please$tick$the$appropriate$box$$*
Male Female
Date*of*birth*DD$MM$YYYY$$$*
Current*home*address***
Postcode
Contact/Mobile*phone*number
National*Insurance*number$if$known
Are*you*completing*this*form*to*tell*us*about*a*change*to*
your*name?***
No
Yes
**Please*give*details*below*
Please*tell*us*why*you*have*changed*your*name*
married,$civil$partnership,$deed$poll$or$other$reason$
Date*of*name*change**DD$MM$YYYY$*
Your%address%details%%Please*tell*us*your*last*two*previous*addresses*if$applicable
Address*1
Postcode
Please*tell*us*when*you*lived*at*this*address
From
To
Address*2*
Postcode
Please*tell*us*when*you*lived*at*this*address
From
To
PAGE*3*
Marriage%or%civil%partnership%details
Are*you*married*or*in*a*civil*partnership?***
No
Yes
**Please*give*details*below*
Married
Civil*
partnership
Date*of*marriage*or*civil*partnership*DD$MM$YYYY$
Have*you*ever*been*married*or*in*a*civil*partnership*in*
the*past?**
*
No
Yes
**Please*give*details*below*
Date*of*marriage*or*civil*partnership*DD$MM$YYYY$
Date*of*divorce*or*dissolution*of*civil*partnership*
DD$MM$YYYY$
Reason*why*marriage*or*civil*partnership*ended*
divorce,$dissolved,$widowed$or$other$reason$
Declaration
Please*sign*and*date*the*declaration*below.*
I*declare*that*the*information*I*have*given*on*this*form*is*
correct*and*complete.*
Signature
Date
What%you%need%to%do%now
Check*that*you*have:
•* completed*all*of*the*questions*that*apply*to*you
•* signed*the*declaration
•* taken*a*copy*of*your*completed*form*for*your*records.
Send*the*original*completed*form*to:*
HM*Revenue*&*Customs*
National*Insurance*Contributions*&*Employer*Office*
National*Insurance*Registrations*
Benton*Park*View*
Newcastle*upon*Tyne**
NE98*1ZZ
For*official*use*only:*National*Insurance*number*traced
