Form NI 205
Termination Certificate
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Particulars of Employer
Name
Address
Street Address
City / District / County
Telephone Number
Phone
Registration Number
Particulars of Employee
I certify that
Title
-- select an option --
Mr.
Ms.
Mrs.
First Name
Surname
Whose insurance number is
was employed in the above-named company for
National insurance weeks
during the period
From
To
Total wages paid during this period was
Total value of contributions deducted from these wages was
Total value of contributions paid to the NIB for this period was
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