NI187

Statement of National Insurance Contributions Due/In Arrears

Employer Information

Employer's Trade Name

Address

Telephone Number

Phone

Employer Registration Number

Contributions Due for Pay Period

Please give separate details of each month within the Pay Period
From DateTo DateContributions DuePenaltyInterestTotalEmployee Count

Number of Employees Being Paid For

Value of Contributions Payable

(a) Balance B/F

(b) Contributions Due

(c) Penalty (If Applicable)

(d) Interest (If Applicable)

(e) Total Amount Due (a+b+c+d)

(f) Amount Paid

(g) Balance C/F

Method of Payment

1. Cash Amount

2. Cheque Amount

Total Amount