Application to pay
National Insurance contributions abroad
How to complete this form
⢠Please read the leaflet NI38 Social Security abroad and the notes on pages 34 and 35 before you complete this form.
⢠Use capital letters, enter dates as DD MM YYYY, tick the right boxes and use black ballpoint pen.
⢠Read, then sign and date the declaration at Part 8 before you send the completed form to us, or we will have to return it to you.
1 About you
Your full name (including your title, Mr, Mrs, Miss, Ms)
Date of birth DD MM YYYY
Your UK address
Do you have a husband, wife or civil partner?
Yes No
If âYesâ, when did you get married or form a
civil partnership?
Did you change your name when you married or
formed a civil partnership?
Yes No
If âYesâ, what was your former name?
Are you divorced, widowed, has your civil partnership been
dissolved or are you a surviving civil partner?
Yes No
If âYesâ, on what date? DD MM YYYY
Your National Insurance number
6
5
3
2
Postcode
4
1
2 About your absence abroad
Name of the countr y you are going to
Your address abroad
While you are abroad, which address would you prefer us
to use to contact you?
UK Abroad
On what date did or will you leave the UK? DD MM YYYY
How long do you intend to stay abroad?
Are you ordinarily resident in the UK?
Please make sure you read the section on
ordinar y residence on pages 6 and 7 in leaflet NI38
before you answer this question
Yes No
9
8
7
12
11
10
3 Employment
Before leaving the UK were you
a) employed? Go to questions 14 and 15
b) self-employed? Go to question 16
c) unemployed? Go to question 17
d) not employed? Go to question 18
13
Do not detach
Please turn over
Name(s) of account holder(s)
Bank/building society account number
Branch sort code
Name and full postal address of your bank or building society
To: The Manager Bank/building society
Address
Postcode
â â
Instruction to your bank or building society to pay by Direct Debit
Service user number
Reference
Instruction to your bank or building society
Please pay HM Revenue & Customs Direct Debits from the
account detailed in this Instruction, subject to the safeguards
assured by The Direct Debit Guarantee. I understand that this
Instruction may remain with HM Revenue & Customs and, if so,
details will be passed electronically to my bank/building society.
Signature
Date
Banks and building societies may not accept Direct Debit Instructions for some types of account.
Please fill in the form and send to: HMRC, NIC&EO, International Caseworker, Benton Park View,
NEWCASTLE UPON TYNE, NE98 1ZZ, England.
9 9 1 1 3 3
CF83 Page 1 HMRC 03/15
click to sign
signature
click to edit