Dublin City University

Wages Payment Form

ALL New Employees should complete this form.
Plus returning employees once there has been a break in service.

Employee Details

Employee’s Name: _______________________________ Staff No: __________________________

Mother’s Maiden Name: ___________________________ School/Unit: __________________________
Employee’s Home Address: _________________________ Date of Birth: __________________________
____________________________
____________________________

Bank Details:
Bank Name: ____________________________ Sorting Code: ____________________________

Branch Address: __ __________________________ Account Number ____________________________

Important to Note: This must be an eight digit number otherwise the bank will reject it and NO PAYMENT will be
received.

Income Tax Details

What is your PPS Number Personal Public Service Number): ____________________________
(Previously known as your PRSI Number).
Have you attached a Cessation Cert. (P45) from your previous employer?: Yes/No*
Or a Certificate of Tax Credits from the Inspector of Taxes made out to DCU?: Yes/No*

Until one of the above is received by us, we will apply Emergency Tax Credits and Emergency Rates of Tax. You should
contact our tax branch immediately at the following address:

North City Revenue District,

14/15 Upper O’Connell Street, Dublin 1. Phone 1890-333-425
Dublin City University Registered No: 4102060U
Pay Related Social Insurance (P.R.S.I) Details
1. Are you currently employed elsewhere?: Yes/No*
If Yes:
(a) You should contact your existing tax branch immediately and request a Nil Certificate of Tax Credits & Standard
Cut off Point made out to DCU (Employer No. 4102060U).
(b) What is your P.R.S.I. contribution class with that employer?: _____________
This is important to complete as it may save on the amount of PRSI deducted from your pay.
2. Are you on a Career Breka, or any other type of leave from any Government Agent: Yes/No*
If Yes:
Please contact Payroll Section to clarify your PRSI position immediately.
3. Are you the holder of a Medical Card or a recipient of a Social Welfare Widow’s/Widower’s Pension, Deserted Wife’s
Benefit or One Parent Family Payment:
If Yes:
Please quote card number/book number ________________
This is important to complete as it may save on the amount of PRSI deducted from your pay.

I certify the forgoing information to be correct to the best of my knowledge and belief, and I undertake to immediately notify Dublin
City University of any change affecting the details given.

Signature: _____________________________ Date: ___________________

WARNING: Failure to complete this form in full will result in non-payment of wages, as it is required to initiate entry/return to
the payroll system. Failure to notify the company of changes affecting the above may result in the incorrect rates of tax/P.R.S.I.
being deducted.
(* Delete as Appropriate)
 Dublin City University
Wages Payment Information
ALL Employees not in DCU Pension Scheme should complete this form.

Following the implementation of the Pension Levy with effect from 1st March 2009, staff not in
the DCU Pension Scheme need to declare their overall personal pension status with regard to any
public service pension scheme. The following details are required to be completed and returned
asap to the payroll department.

In Relation to the Public Service Pension Related Deduction.

1. Are you a member of a public service pension scheme? Yes/No

2. Do you have, or have you a future entitlement to, a benefit under
a public service pension scheme? Yes/No
3. Have you opted out of such a scheme? Yes/No
4. Do you receive a payment in Lieu of membership in such a scheme? Yes/No
(* Delete as Appropriate)

I certify the foregoing information to be correct to the best of my knowledge and belief, and I undertake
to immediately notify the Payroll Department at Dublin City University of any change affecting the
details given. I understand that if I am a member of a public sector pension scheme or have a future
entitlement to a benefit under such a scheme that I will be liable for the pension levy.

Signature: ____________________________ Date:

Name: _______________________________ School/Unit: _______________

(Block Capitals)
I.D. No: _________________________________

IMPORTANT NOTE: Failure to complete this form in full will result in non-payment of wages, as it
is required before processing any payments after 1st March 2009.

For further information on the pension levy please see:

http://www.education.ie/home/home.jsp?pcategory=10815&ecategory=47130&language=EN