ࡱ>  '\pNHSPA Ba==xX/#8Y@"1Arial1Arial1Arial1Arial1Arial1&0  Arial Black1Arial1Arial1Arial1Arial1Arial1Arial1Arial1Arial1 Arial1Arial1Arial1Arial1Arial1Arial1Arial""#,##0;\-""#,##0""#,##0;[Red]\-""#,##0""#,##0.00;\-""#,##0.00#""#,##0.00;[Red]\-""#,##0.005*0_-""* #,##0_-;\-""* #,##0_-;_-""* "-"_-;_-@_-,)'_-* #,##0_-;\-* #,##0_-;_-* "-"_-;_-@_-=,8_-""* #,##0.00_-;\-""* #,##0.00_-;_-""* "-"??_-;_-@_-4+/_-* #,##0.00_-;\-* #,##0.00_-;_-* "-"??_-;_-@_-#,##0.00;#,##0.00#,##0.00;\(#,##0.00\)#,##0;\(#,##0\)2-_-* #,##0.0_-;\-* #,##0.0_-;_-* "-"??_-;_-@_-.)_-* #,##0_-;\-* #,##0_-;_-* "-"??_-;_-@_-#,##0.0;#,##0.0 #,##0;#,##0 0.0%                + ) , *    #   #  "        #  "      (  #<  "8  "8   H   h  "x  "x  !8  #|     #   8  "   (  "<  "  #  #  #<  ! !   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"<@@ "8@ "8 @ "8@ "8 "8  #|@ @*  #|@ * "8@@ "8@ "8 @ "8@ "8 "0@ "0 @ "0@ "0 "0  #|@ @ #0@  "8@@   8@ @  0@   <@ @  #|@ @*  #|@ *  #<@  "<@ @ "0@  " "      "   <@@  4 @  4@  4   |@@*  t @*  t@ *  t *  "<@ @  "<@  |@@*  x @*  x@ *  x *  <@  "|@ @ "8@  #|@@* #|@ *  "<@ @ "<@  "   "0@@ `d3Page 1uPage 2Page 3Page 4,`ibZ  3  @@  rABC Host PCT/LHBDEBox No.Step 1= Total NHS and non-NHS incomeTurn to Page 2Provider's full name-Provider's NI number or Pension Scheme Ref No9Calculation of pensionable profits drawn down as a salary:Calculation of pensionable profits drawn down as dividendsNHS pensionable payF ( This is the company's total NHS income.aPlease refer to the 'Limited Company Guidance And Completion Notes' when completing this Schedule-Calculation of the company's NHS income ratioStep 3XStep 2 State the amount of income included in Box 1 above relating to non-NHS income. By Box 16Step 1 Enter your gross company salary for the year.pensionable dividends.\ Deduct the non-NHS income stated in Box 2 from the income stated in Box 1. = Company's full nameG&Type of contract; i.e. GMS, PMS, APMS, SPMS, etc.>State the company's total NHS and non-NHS income (adjusted for'Calculation of pensionable profits pool)dividends to profits earned from the NHS.\NOT to be completed by a salaried GP employed by a limited company who is not a shareholder.2Company accounts year end falling in the tax year Divide Box 3 Total NHS Income-Calculation of NHS income: total income ratio)This is your gross NHS pensionable salary<This results in your net dividends in respect of NHS income.4This is your share of potential pensionable profits Step 6:This is your current year undistributed pensionable profitlThis is your total undistributed pensionable profit carried forward. (See below if this figure is negative)Step 2IStep 4 Enter the figure from Box 8. pStep 5 Deduct the figure in Box 9 from the figure in Box 8; this is your NHS = ;Step 2 Multiply the figure in Box 7 by the figure in Box 4/Calculation of NHS Pension Scheme Contributions Amount in boxContributions alreadypaid and recordedmultiplied by % by the PCT for Contributionstated in boxesdue lessin respect of contributions Relevant %contributions duepaidEmployee pension Added years pension>Employer pension <Total amount of contributions (over)/under paid for the yearkStep 1 Add the figures in Boxes 6 and 10 together and enter the total in Box 11. =rTo be completed by all GP (and non-GP) providers who are shareholders in a limited company that holds a GMS, PMS, "Company's employing authority codeHIJTick this box if figures in this certificate are from a provisional returnJMemoEEnter your provisional SENIORITY entitlement per the company accounts18a/Additional explanatory information, if required DECLARATIONYNow you must read and sign the statement below and send this completed Certificate to the@If you give false information you may be liable for prosecution.GP (or non-GP)Provider signatureDateuAn electronic spreadsheet version of the Certificate is acceptable subject to a paper page 4 being provided with the Provider's signature.PCT/LHB AgreementfI have checked the figures shown in boxes 13, 14 and 15 of this Certificate and am satisfied that theyaappear consistent with the relevant NHS work and income that this PCT/LHB is aware of and confirmPCT/LHB authorised signatureDate Provider's nameNI number or Pension SchemeReference number 16 to 19 isTurn to page 3Turn to page 4\Enter your gross salary from the company to which this Certificate relates for the tax year,Step 2 Step 1 XTotal net dividneds paid to you in the tax year by the company to which this Certificate 3Multiply the figure in box 5 by the figure in Box 4[Step 4 Enter the figure in Box 42, if negative; this is the restriction of the pensionable\Enter your brought forward undistrubted pensionable profits figure, if positive, from box 424Multiply the figure in Box 38 by the figure in Box 4=Step 5 Deduct the figure in Box 40 from the figure in Box 39Add box 37 to box 41CIf the figure in Box 42 is negative, it should be entered in Box 9.LPension Scheme Contributions for the year to which this Certificate relates.Company's registered numberKREnter the gross amount of any outside salaried appointment in your name paid into Contributions deducted in error fromshareholder's salaryfrom the company to whichtraining grants, pooled OOH etcPtax purposes) excluding shareholders' income that has been pensioned separately.  from this one company contract.=Tax and NHS Pension Scheme year end, to which the pensionableincome at box 13 relate.Jthe company, and pooled with other income, that has already been pensionedcompany incomethis Certificate relates;z"I confirm that the information provided on this Certificate is correct and is consistent with my HMRC tax return. I alsovStep 2 Enter your theorectical share of the profit after tax but before dividends earned in respect of the accountingthis boxMGP Provider (or non-GP Provider) Shareholder of a qualifying Limited Company 9APMS or SPMS contract and is a Scheme Employing Authority(appropriate PCT/LHB as soon as possible.confirm that my declared NHS pensionable pay in Box 13 does not include any non-NHS (i.e. private) income or NHS income pensioned elsewhere."Company's NHSPS Emploing Authority CodeWper box 1 of the Employment page E1 your personal tax return. This must be net of any /employment expenses claimed on your tax return.2relates, per box 3 of page TR3 of your tax return.2of your previous years limited company schedule. -Certificate of Pensionable Income for 2008/09jThe main 2008/09 Certificate may also need to be completed if not all of your pensionable earnings derive (e.g. 30.06.08, 31.03.09)MDeduct box 12 from box 11.This is your pensionable company income for 2008/09 AEnter 'YES' if earnings cap applies to your added years purchase.TAmount of pension cap for Added Years purposes for the year (where this is below the % Zpublished amount because of income pensioned separately, please provide details in box 43)18b2008/09dyear ending in the tax year to 5 April 2009, based upon the ratio indicated in the guidance notes tocontributions*Money Purchase AVC*Money Purchase amount*Additional Pension amount*v* You must enter zero or the actual percentage in boxes 16, 17 & 18, and zero or the actual amount in boxes 18a & 18b.Pensionable pay for employeeand employer contributionsPensionable pay for addedyears contributions]that they have been used to confirm, record and pay over to NHS Pensions the appropriate NHS J(To be signed by the host PCT/LHB at year-end or when the contract ceased)u(Note for PCTs/LHBs: The pensionable profit is the amount to be declared on the SD55; i.e the amount in box 13 or 14)7 mBxMY.L!,|M!" 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