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Income Threshold declaration
"
*
" indicates required fields
Step
1
of
3
– Personal Details
33%
Personal Details
Given Names
*
Family Name
*
Mobile Tel
Home Tel
Email
Income from Employment
Do you receive income from employment
*
Yes
No
Please enter your total gross income (before tax) from employment per
Pay period
*
Week
Month
Annual
Week
*
(calculated annual earnings)
Month
*
(calculated annual earnings)
or Year
*
Evidence of Wage
You must provide evidence of your wage, this can be in the form of:
a payslip (within previous 3 months)
Universal Credit statement (within previous 3 months)
a Contract of Employment stating salary
Self-Employed Only
– a Tax Return for the previous year
File Upload
*
Drop files here or
Select files
Accepted file types: (jpg, jpeg, png, pdf, tiff, bmp), Max. file size: 10 MB.
Evidence provided
*
please select the evidence you have provided
Payslip (within previous 3 months)
Universal Credit Statement
Contract of Employment stating salary
Self-Employed only – Tax return for previous year
Date of Evidence
*
Please provide the date of your evidence, for example the date on your statement or payslip
DD slash MM slash YYYY
Declaration
Please note that these figure may be overridden if staff see different amounts of income on uploaded evidence or for joint benefit claims.
Total Annual Income
Total Annual Income
Total Annual Income
Declaration 1
*
I declare that all of the information I have provided is accurate and is a true reflection of my employment status.
Declaration 2
*
I understand that if I have declared false information Skills & Learning may take action against me to reclaim fees and any support costs provided.
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Signature
*
Please draw your signature either with your mouse or if you have a touchscreen with your finger or stylus.
Today's Date:
*
Day
Month
Year
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Staff Notes and Summary
Please provide some summary notes of your threshold assessment. Your notes may be used in future audits to provide evidence for a learners funding decision.
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Staff Signature
Please draw your signature either with your mouse or if you have a touchscreen with your finger or stylus.
I confirm that to the best of my knowledge, the information on this form is true and accurate.
This field is hidden when viewing the form
Date Signed
DD slash MM slash YYYY
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