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Currency [0]/Explanatory TextG5Explanatory Text % 0Good;Good  a%1 Heading 1G Heading 1 I}%O2 Heading 2G Heading 2 I}%?3 Heading 3G Heading 3 I}%234 Heading 49 Heading 4 I}% 5InputuInput ̙ ??v% 6 Linked CellK Linked Cell }% 7NeutralANeutral  e%"Normal 8Noteb Note   9OutputwOutput  ???%????????? ???:$Percent ;Title1Title I}% <TotalMTotal %OO= Warning Text? Warning Text %XTableStyleMedium9PivotStyleLight16`uPage 1Page 2Page 3GPage 4Page 5, bZ 3  @@   2BoxABC Host PCT/LHBDEHGP Private fee (self employed) accounts year end, where private fees areFGHI]All entries on this form should be completed with reference to all income and expenditure in PCalculation of GP share, or non-GP share of total NHS income and non-NHS income,for the expenses ratioBox No.Step 1=Specify your GP (or non-GP) share of income declared in boxes@3.29 & 3.50 of the full practice partnership tax return of your ;share of boxes 3.29 and 3.50 minus your share of box 3.71). Step 2 +Step 3Step 48Add your other medical related income, before expenses, Adeclared elsewhere on your tax return, adjusted for tax purposes.Step 5 -pensioned separately = Step 1 3State the amount of income included in Box 1 above relating to non NHS income Step 23State the amount of income included in Box 2 above 3State the amount of income included in Box 3 above 3State the amount of income included in Box 4 above Step 5 Divide Box 12 Total non-NHS IncomeBy Box 6Calculation of total expenses,Add your employed expenses declared in boxes$in respect of medical related income5 Add your medical related expenses claimed elsewhere ;or set against income declared elsewhere on your tax return5Add interest paid on a loan for professional purposes"Calculation of Pensionable Profits)Taxable profit from practice partnership (Box 1 - Box 14)+Taxable profit from self employment pages (Box 2 - Box 15).Taxable employed income less related expenses (Box 3 - Box 16)4Other medical related income declared on tax return (Box 4 - Box 17)Less: Less LessAdd JIf you have not used the standard method of apportioning non-NHS expenses FN.B. USING THE ALTERNATIVE OR YOUR OWN METHOD OF CALCULATING NON-NHS @EXPENSES CAN AFFECT THE LEVEL OF YOUR SUPERANNUABLE PRACTITIONERFPAY. NHSPA CANNOT OFFER ADVICE ON WHICH METHOD MAY BE MOST APPLICABLECOR BENEFICIAL TO YOU. PROFESSIONAL ADVICE MUST BE SOUGHT FROM YOURBACCOUNTANT OR INDEPENDENT FINANCIAL ADVISER SHOULD YOU REQUIRE IT. Your interest paid (Box 18)Less:xAdd:Memo'Pension overlap profits brought forward%Pension overlap generated in the year-Deduct pension overlap profits used this year'Pension overlap profits carried forward This is your Pensionable profit Memo /Calculation of NHS Pension Scheme Contributions Contributiondue less Relevant %in respect of practice incomeEmployee pension contributionsAdded years pension>Employer pension Calculation of non-NHS expensesXIf the standard method shown cannot be used, the alternative method shown must be used. [Where the GP, or non-GP is required to use the alternative method, accounting records will Rneed to be amended to record this information adequately on an item by item basis.<The standard method for the calculation of non-NHS expenses:Divide Non-NHS income (Box 12)By total income (Box 6)?The alternative method for the calculation of non-NHS expenses:Add*Expenses wholly attributable to NHS income.Expenses wholly attributable to non-NHS income3Expenses that cannot be separately allocated to NHSor non-NHS income:Ratio for allocation of expenses not separately allocated:Divide Non-NHS income (Box 12) expenses +Or your own method cIf the above calculation and allocation ratio does not give you a fair conclusion, you must use an [alternative method of your own, and clearly explain your reasons and methodology in the boxKIf you cannot use the standard or alternative non-NHS expense calculations =explain your own method of non-NHS expense calculation here: GP DeclarationZNow you must read and sign the statement below and send this completed Certificate to the DatePCT/LHB AgreementXand confirm that they have been used to confirm, record and pay over to the NHS Pensionsrelates.PCT/LHB authorised signature@medical practice, adjusted for tax purposes (i.e. reflects your  Total NHS and non-NHS income%GP SOLO incomeTurn to Page 2Turn to Page 3)or set back against previous years incomeTurn to Page 4Contributions alreadypaid"Your total non-NHS income (Box 12)Turn to Page 5pensioned separatelyTotal non-NHS expenses FThis is your total non-NHS income for the purposes of the income ratio>This is your total expenses in application of the income ratioYparticularly regarding pooled salaried appointments. Do not include GP SOLO income here)9 < relate to (enter NHSPS date)2Add your medical related employed income reflectedreturn<Total amount of contributions (over)/under paid for the yearpractice accounts7Enter the amount of SENIORITY allocated to you per the   HGP SOLO income included above for the accounting year of the SOLO income that this Certificate refers to."NI number or Pension Scheme Ref No%Practice Reference Number and Scheme   Employing Authority code=Practice accounts year end, to which this Certificate relatesJ9Calculation of non-NHS income: Total medical income ratiopaid and recorded paid and recordedGP (or non-GP)Provider's signatureAn electronic spreadsheet version of the Certificate is acceptable subject to a paper page 5 being provided with the Provider's signature.c(To be signed by the host PCT at the end of the Provider's contract where it ceases before year endProvider's name Amount in boxmultiplied by % stated in boxescontributions due*Type of contract (ie GMS, PMS, SPMS, APMS)Total of boxes 20 to 23GAny amount included in boxes 20 to 23 pensioned separately (see note 26LAny other pensionable NHS GP income NOT in boxes 20 to 23 that has not been GYour non NHS expenses (Box 61, 67 or from Box 68 under your own method)7tick this box and enter your explanation in the box 68. GP SOLO income entered in box 3237a37b37c38a42a38 or 39provided on page 5 (Box 68).b(The pensionable profit is the amount to be declared on the SD55; i.e. the amount in box 38 or 39)mTo be completed by all GMS, PMS, SPMS and APMS GP (and non-GP) Providers who are partners or 'single-handers'%not fed through the Practice accountsREnter 'Yes' in this box if figures in this Certificate are from a provisional tax %respect of the GP or non GP Provider DPlease refer to the guidance notes when completing this Certificate 40 to 43 is by the PCT/LHB for by the PCT/LHB forv"I confirm that information provided on this Certificate is correct and is consistent with my HMRC tax return. I also `confirm that my declared NHS pensionable pay does not include any non NHS (i.e. private) income.cI have checked the figures shown in boxes 38 and 39 of this Certificate and am satisfied that they Uappear consistent with the relevant NHS work and income that this PCT/LHB is aware of`Division the appropriate NHS Pension Scheme contributions for the year to which this Certificate&Practice Reference Number (see note D)Provider's full nameATax and NHS Pension Scheme year end, which the profits at Box 38 %Multiply Box 33 by the fraction 9Deduct your income included above in Boxes 1, 2, 3 and 4 :Deduct your income included above in Boxes 7, 8, 9 and 10 OThis is your total medical NHS & non-NHS income for the purposes of the income ratio[Calculation of GP (or non- GP) share of total non-NHS medical income for the expenses ratioTNOT to be completed where the Practice is a limited company, or by any Salaried GPs.  x (Box 65)contributions* x Expenses (Box 19)'Take the total expenses shown in Box 19QIf you give false information you may be liable to investigation and prosecution.Mof the self-employment (full) pages of your tax return, in respect of medical7Add your self employed income declared in boxes 14 & 15Drelated work, adjusted for tax purposes (i.e. reflects boxes 14 plus4in box 1 of the employment pages of your tax return.?Add the total of your self emp<loyed expenses declared in box 30Mrelated work, adjusted for tax purposes (i.e. reflects the total of boxes 30 %on the self employment (short) pages.:17, 18, 19 & 20 of the employment pages of your tax returnKGP (and non GP) Providers Annual Certificate of Pensionable Profits 2008/09(e.g. 30.06.2008, 31.03.2009) (e.g. 30.06.2008, 31.03.2009)@Enter 'Yes' if earnings cap applies to your added years purchase 15 minus 61)\Use boxes 8 & 9 adjusted for tax purposes where income is below 67,000 on the 'short' pages^3.47, 3.48 & 3.64 of the full practice partnership tax return, in respect of medical related QSpecify the total of your GP or non-GP share of expenses declared in boxes 3.46, A& 3.64 minus your share of box 3.69 plus your share of box 3.70).cwork, adjusted for tax purposes (i.e. reflects the total of your share of boxes 3.46, 3.47, 3.48, & 56 minus box 60).$not accounted for in boxes 14 to 17 SUse box 19 plus boxes 22, 23 & 24 minus boxes 25 & 26 where income is below 67,000purposes"and employer conributions purposes Pensionable profit for employee Lappropriate PCT/LHB as soon as possible and NO LATER THAN 28th February 2010dor at 31 March 2009 where the appointment has been throughout the year - see notes to Boxes C and D)Ypublished amount because of income pensioned elsewhere, please provide details at Box 68)UAmount of Pension Cap for Added Years purposes for the year (where this is below the  % 42b2008/09Money Purchase AVC%*Money Purchase amount*Additional Pension amount*k*You must enter zero or the actual % in boxes 40, 41 & 42, and zero or the actual amount in boxes 42a & 42b#Pensionable profit for Added Years @ *ABfBSC@D:8FFGH|IwJ EK Mk 2N Pe QvQ*RST)V1WX Zb[M]-Q_laJc| e=fcc PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!ÄA theme/theme/theme1.xmlYOoE#F{oc'NjGuرhF[xw;23NjHH q Jĥ|@_73xM6{o~(fIyWk"޽aJCR$'Mnlu"^T$}*OIB.bQn̖kC 0>ACMȉ<&J &M5BNe tY>?#!mfKx=[Ԃu}ˆ ~umoLz^W/}ةLo;9iwk/_tV[,ac߬56YvYp1ϡAz 9ۮ7ެe ."Zk1~EȰ RӔ/x$( :7vʗsSj{"bF^x^xz?>~,ɸ7Gg_zy5^|?}V I򋧿>O~I|SQ>19D{<Ÿ8ߊaG@tOE*\ʻ/ yToN:"1Q(v; y4<$jbRa|PŻǴI Y3wJG݈8b2(<& QHT^w/B(`Z!94[Mc˴j`jG7;Q]o YC5*CocU 9 IQ/ RV+`%*;æWѼ9/#~7qZ$*cߓrUngN>%OOi Dh[BvoLJƌB6>p&>w O]>_x.eywQ,5,^<ؾt&9 ԔEЇIIqhJ#f6kAS&2D)p3ӕ5teO`jvzEOG)9cshger-# ~fu-ԙՍh&9܊- 6 AлY3hX"M$#Fz6#b.w*lyhĭɾ̮]nR3+=,)'Kak.zi X 8Ka6!_ 5[ M܆< kW Ds/Z/j@&8?&5- C⫲K3Zw1K|D!`~J0A?Uֶy&,Xg1K#[y$[BTV)bBRvVt=낕@[\׶Dž8d4~_@`rx \kp*O69mY&ԧ HE]HKN!Vj%2BƣJԊ=" u\ӵC&Y0>g4&oN)j rihr"VTU,koy#ŬjQJpRk3܎Ws;ɢ!JT~u "֠ۀW_ Nq֙4)ڬuZˋw֒TvќXHegvtm,{2Da*20V=CoOQ2'@C8D.IrG[Ȥiࠆ)d͛|?&f9>b|w##(ɇ"C *_p=ce΂aenv*Wm瓗{varAˇ$IDpKs6* ʢG0egAnlCYt֏$Ysă)2|FS` uz'Xr*󠍒F`Bi m/Ҷj9Xrmox86tFo˜ b`>ASDbƟPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!ÄA theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]   KIY  dMbP?_*+% &CPage 1&~?'~?(~?)~?M \\MSB1\BlackpoolFloor1CopierDE`)/ 4dXXA4X)SPLXX)IMSLGPCLXL 4 ++++4 L -e4 4 L -dInTray1InTray2InTray3InTray4InTrayLCTInTrayManualdd}}WM_101URGENTURGENTArialHXXPsRGB_ArialCourier NewTimes New RomanSymbolWingdings ArialCourierTimes New RomanSymbolWingdings#iv< 4 EXCEL.EXE ʇ)a(" 4XX `? 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