Application to pay

National Insurance contributions abroad

How to complete this form

Read the leaflet NI38 Social Security abroad and the notes on pages 31 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’ll have to return it to you.

1 About you 2 About your absence abroad

1 Your full name (including your title, Mr, Mrs, Miss, Ms) 7 Name of the country you’re going to

8 Your address abroad

2 Date of birth DD MM YYYY

3 Your UK address

9 While you’re abroad, which address would you prefer us

to use to contact you?

Postcode UK Abroad

10 On what date did or will you leave the UK? DD MM YYYY

4 Do you have a husband, wife or civil partner?

Yes No
If Yes, when did you get married or form a 11 How long do you intend to stay abroad?
civil partnership?

Did you change your name when you married or 12 Are you ordinarily resident in the UK?
formed a civil partnership? Make sure you read the section on ordinary residence
on pages 6 and 7 in leaflet NI38 before you answer
Yes No this question
If Yes, what was your former name?
Yes No

3 Employment
5 Are you divorced, widowed, has your civil partnership been 13 Before leaving the UK were you
dissolved or are you a surviving civil partner?
a) employed? Go to questions 14 and 15
Yes No
If Yes, on what date? DD MM YYYY b) self-employed? Go to question 16

c) unemployed? Go to question 17

6 Your National Insurance number d) not employed? Go to question 18

Please turn over

Do not detach

Instruction to your bank or building society to pay by Direct Debit

Fill in the form and send to: PT Operations North East England, HM Revenue and Customs, BX9 1AN,
United Kingdom.
Name(s) of account holder(s) Service user number
9 9 1 1 3 3
Bank/building society account number Reference

Branch sort code Instruction to your bank or building society

Please pay HM Revenue and Customs Direct Debits from the
— —
account detailed in this instruction, subject to the safeguards
Name and full postal address of your bank or building society assured by The Direct Debit Guarantee. I understand that this
To: The Manager Bank/building society
instruction may remain with HM Revenue and Customs and, if so,
details will be passed electronically to my bank/building society.
Address
Signature

Postcode Date

Banks and building societies may not accept Direct Debit instructions for some types of account.

CF83 Page 1 HMRC 09/19

 3 Employment continued 6 Application to pay voluntary contributions
14 What date did you last pay National Insurance 22 I wish to apply to pay voluntary contributions at
contributions? DD MM YYYY
Class 2 Class 3

Voluntary Development Worker Class 2

15 Your employer’s address
23 I wish to pay by
Fill in the Direct Debit form on page 1,
Direct Debit inserting your National Insurance
number under Reference.
Six monthly Not available for Class 3 National
Postcode Direct Debit Insurance contributions

Annual payment
16 What date did your self-employment end? DD MM YYYY
Agent
If you’ve chosen to use an agent, give their full name
17 When did you last claim Jobseeker’s Allowance? and address.
DD MM YYYY

4 Self-employment/employment abroad
Postcode
18 Are you or will you be working abroad for an employer?

Yes No 24 If you’ve chosen to pay by Direct Debit, how do you wish to

pay current tax year arrears, if any?
If Yes, what is their UK address?
Direct Debit Sterling cheque

7 Shortfall of National Insurance

contributions
Postcode
25 Do you want to know about any shortfall of
What is their address abroad? National Insurance contributions that you can pay?

Yes No

8 Declaration
I declare that I have read leaflet NI38 and that the
Who do you have your contract with? information I have given applies to me and is true to the
best of my knowledge and belief.

Signature
What date did your employment abroad start?
DD MM YYYY

Date

19 Are you or will you be self-employed abroad? Daytime phone number

Yes No
If Yes, what date did/will your self-employment
Return the completed form to:
abroad start? DD MM YYYY
PT Operations North East England
HM Revenue and Customs
BX9 1AN
United Kingdom
20 Are you or will you be employed directly by an overseas
government or international organisation? If you’re a Volunteer Development worker send the completed
form to your recruiting organisation, see leaflet NI38 page 15.
Yes No Not known
If Yes, who has right of dismissal? For example Ministry
of Education, Health Service, Armed Forces

5 Volunteer Development workers

21 What is your salary or wage?
We need to know about your earnings for National
Insurance contribution purposes. Include all cash
allowances paid by your employer, but do not include
benefits in kind or any cash allowances not paid by
your employer.

£ •
Weekly
Monthly

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