Umbrella Company & Limited Company Accountants

National Insurance Number*

Address (House Number / Name)*

Home telephone Number

Are you registered with HMRC as self-employed?* Yes No

*If YES, what is your / company Unique Tax Reference Number (UTR)

If NO, please contact the HMRC helpline on 0845 915 4655 and register your CIS status.

Company Registration Number

Partner’s Name (If Applicable)

Partner’s UTR or National Insurance number (If Applicable)

The Partner’s Company Registration Number (If applicable)

Name of Agency (Including Branch)*

Agency Contact Name*

Contract Start Date End Date

To be paid Weekly Monthly

How long will the assignment last?

Where is the assignment located? UK Based Abroad Off Shore

How would you classify the assignment? Clerical Trade Technical Professional

Are you currently working on assignments for more than one agency? Yes No

Would you like additional Personal Accident insurance cover (+£2.50) Yes No

Colleague/Workmate? (Please provide name) Yes No

Internet? (Please provide website) Yes No

Previous Danbro Client? Yes No

Post (Please provide if different from client address) Yes No

I confirm I have read and understand the Danbro CIS Health & Safety Guide, that I fully understand the contents and agree to comply with the policies and procedures set in it.

Do you provide your own plant, equipment and/or materials to carry out your work? Yes No

Do you receive training from anyone you currently provide services for? (Excluding health and safety training) Yes No

Are you entitled to holiday pay? Yes No

Are you entitled to sick pay? Yes No

Are you entitled to a company pension scheme or other benefits? Yes No

Are you entitled to pay from Danbro Ltd for work cancelled due to bad weather? Yes No

Are you under any obligation to receive future assignments? Yes No

Do you have the right to substitute someone else to do the job (e.g. If you feel ill, would you be able to bring an equally skilled worker to complete the job?) Yes No

Are you entitled to terminate an assignment at any time? Yes No

Are you accountable for all your own expenses? (E.g. Travel to and from work?) Yes No

Are you entitled to work on more than one assignment at any time? Yes No

Upon receiving instructions of the assignment; are you able to determine the method in which you are perform the services? Yes No

Are you able to choose the hours to perform your work; taking into account assignment deadlines and opening hours of the place of work? Yes No

Do you have other engagements other than this one? Yes No

I declare that all the information I have provided is correct and I understand that it is my responsibility to inform Danbro Ltd of any changes to my personal CIS status, bank or agency details as soon as possible. I also agree to the terms & conditions set in the Danbro contract for CIS services.

CIS Application Form

1. Client Details

CIS Self Employment Assessment