SAL - PERSONAL RECORD FORM
Please note it will not be possible to process payments without this form.
Please complete ALL sections in BLOCK CAPITALS.
Payroll
Number
Department
Title
Surname (as official documents)
Forename (s) (as
official documents)
When completing personal details please ensure that your name is written as it appears on official documentation e.g. passport to ensure our records comply with HMRC regulations.
Preferred Forename
Home Address
Please note your address
May be passed onto your
Department for their records
Post Code
Telephone No
Mobile No
Date of Birth
National
Insurance No
D
Start Date of paid
Work with the
University
D
M
M
Y
Y
A
M
D
D
M
M
Y
A
N
N
N
N
N
N
A
F
Please tick as appropriate
Y
Payment Details – All payments are made by BACS
For overseas accounts please use the Foreign Bank details form available on the Payroll website
http://www2.warwick.ac.uk/services/humanresources/payroll/expenses/ and submit with this form.
Sort Code
-
-
Name of Bank
_________________________________________________________________
Account Number
Bank Branch
_________________________________________________
Account Name
Bank Address
_________________________________________________________________
Building Society
Roll Number
_________________________________________________________________
Emergency Contact Details (Please provide details to be used in case of emergency)
Contact Name
Telephone No
Mobile No
Please note this information may be passed to your department but will only be used in the event of an emergency
I confirm that the personal information given on this form is correct. I also agree that in the event of overpayment of any salary or other remuneration, the
University is entitled to make the relevant deduction from any subsequent payment(s). The University will let you know and agree in advance the relevant
deduction, but its failure to do so will not affect its right to reclaim the overpayment.
Signed _______________________________________________________ Date __________________________
Please note a typed signature is not valid
OFFICE USE ONLY - HR
PSe Updated
Actioned by _______________________ Date ______________
Changes made to form between receipt in HR and forwarding to Payroll and reason(s) why:
Initial __________ Date ____________
TAXATION AND STUDENT LOAN
Employee
Number
Department
Surname (as official documents)
Taxation Status – Do not leave this section blank.
Please confirm your current circumstances
Please read all of the statements carefully. You must enter X in the ONE box that applies to you.
A
This is my first job in the current tax year (6 April onwards). I have no other forms of income and I do not receive a pension or state
B
I have received taxable Job Seekers Allowance, Incapacity Benefit, Employment and Support Allowance or this is not my first job in the current tax
year (6 April onwards). However, this is now my only job or main (highest earning) job. I do not receive a state or occupational pension.
C
This is a secondary position (i.e. I work for another organisation excluding Unitemps) or I am in receipt of a state pension.
D
benefits.
I have been employed by Unitemps in the current tax year (6 April onwards). If you have ticked this box you MUST tick ONE additional statement
below
I no longer wish to be employed by Unitemps. (NB Your Unitemp role will be closed down and a P45 will be issued to your new University
post.) (Payroll – advise Unitemps agency employee made to leave.)
I am still engaged with Unitemps and I wish Unitemps to be my main source of income.
I am still engaged with Unitemps and I wish the University to be my main source of income.
NB you will need to contact HMRC to change your tax code telephone 0300 200 3300. UOW tax reference – 190/U50, Unitemps tax
reference 120/ZA76059. Until confirmation is received you will be taxed at basic rate, currently 20%, with no allowance.
Student Loan – Please confirm your current circumstances
Please read the following statements carefully and enter an X in each box which applies to you
Statement 1
I have a Student Loan which is not fully repaid. (If you answer yes to statement 1 please go to statement 2)
Statement 2
I am repaying my Student Loan direct to the Student Loan Company by agreed monthly payments and my employer shouldn’t deduct loan
repayments from my pay. (If you answer yes to statement 2 then you do not need to answer statements 3 or 4)
Statement 3
I have a Plan 1 student loan
You have a plan 1 student loan if you lived in Scotland or Northern Ireland when you started your course or you lived in England and Wales
and started your course before 1st September 2012
Statement 4
I have a Plan 2 student loan
You will have a plan 2 student loan if you lived in England or Wales and started your course after 1st September 2012
Statement 5
I finished my studies before the last 6th April
I confirm that the personal information given on this form is correct. I also agree that in the event of overpayment of any salary or other
remuneration, the University is entitled to make the relevant deduction from any subsequent payment(s). The University will let you know
and agree in advance the relevant deduction, but its failure to do so will not affect its right to reclaim the overpayment.
Signed _______________________________________________________ Date __________________________
OFFICE USE ONLY – PAYROLL
PSe Updated
Actioned by _______________________ Date ______________
Changes made to form between receipt in HR and forwarding to Payroll and reason(s) why:
Initial ________
Date _________
May 2016
PENSION INFORMATION
Employee
Number
Department
Surname (as official documents)
The University of Warwick is required to comply with government legislation to enrol eligible workers automatically into an occupational pension scheme. This
process is called auto enrolment. Your offer letter will outline your eligibility for one of the University’s pension schemes. Details of the scheme and the
associated salary sacrifice arrangement will also have been provided with the letter.
GRADES 1-4 ONLY – Please complete sections 1a and 1b.
1a. Joining the workplace pension scheme

I wish to join the University of Warwick Pension Scheme Defined Contribution Section (UPS DC) workplace pension scheme.
I would like to contribute the percentage below of my monthly salary:
1%☐
2%☐
3%☐
4%☐
5%☐
(The University will contribute an additional amount equal to twice that of your chosen percentage into your pension pot. If you do not select a
percentage you will be enrolled at the default rate - currently 1%.)

I do not wish to join the UPS DC workplace pension scheme - please send an “opt out/non-joiner” form to my home / office address.* Please return to
HR Pensions, University House as soon as possible. If a completed form is not received by HR Pensions before your first pay is calculated you may be
automatically enrolled into the scheme.
1b. Pension contributions through ‘Salary Sacrifice’


I would like my contributions to be paid by salary sacrifice. I understand that I will not be entitled to a refund of my contributions if I leave the scheme
before completing 2 years.
I do not wish my contributions to be paid by salary sacrifice – please send an “opt out/non-joiner” form to my home / office address.*
* Delete as applicable
Signed _______________________________________________________ Date __________________________
GRADES 5 and above ONLY – Please complete sections 2a and 2b.
2a. Joining the workplace pension scheme




I am a current or former member of the Universities Superannuation Scheme (USS) and I wish to join the USS workplace pension scheme.
I will be a new member of the Universities Superannuation Scheme (USS) and I wish to join the USS workplace pension scheme.
I am currently in receipt of a USS pension and I wish to join the USS workplace pension scheme. I understand that increased contribution rates apply to
accrue additional benefits.
I do not wish to join the USS workplace pension scheme - please send a “notice to opt out of pension saving” form my home / office address.* Please
return to HR Pensions, University House as soon as possible. If a completed form is not received by HR Pensions before your first pay is calculated you
may be automatically enrolled into the scheme.
2b. Pension contributions through ‘Salary Sacrifice’


I would like my pension contributions to be paid by salary sacrifice. I understand that I will not be entitled to a refund of my contributions if I leave the
scheme after the first three months of joining.
I do not wish my pension contributions to be paid by salary sacrifice – please send a “salary sacrifice opt out form” to my home / office address.*
* Delete as applicable
Signed _______________________________________________________ Date __________________________
NHS Pension Scheme (Medical School Only)
If you have paid into the NHS Pension Scheme in the last 12 months and will be undertaking work associated with the medical school, please contact HR
Pensions for confirmation of your eligibility to continue contributing into the NHS Pension Scheme whilst employed by the University of Warwick.
Signed _______________________________________________________ Date __________________________
OFFICE USE ONLY – PENSIONS
Auto enrolment eligibility:

USS

UPS Heritage

UPS Enterprise

UPS Heritage

UPS Enterprise
Personal choice scheme

USS
Pensions Administrator __________________________________________

NHS
Date ___________________
May 2016
EQUALITY AND DIVERSITY
Employee
Number
Department
Surname (as official documents)
The University is required to collate and report on equality and diversity information.
Ethnicity
In order for us to comply with this requirement could you choose the entry that best describes your ethnicity?
White
10
Asian/Asian British-Pakistan
32
Mixed-White and Asian
43
Gypsy or Traveller
15
Asian/Asian British-Bangladesh
33
Other Mixed Background
49
Black/Black BritishCaribbean
Black/Black British-Africa
21
Chinese
34
Arab
50
22
Other Asian Background
39
Other Ethnic Background
80
Other Black Background
29
Mixed-White and Black Caribbean
41
Prefer Not to Say
98
Asian/Asian British-India
31
Mixed-White and Black African
42
Please enter your nationality
Religion
What is your religion?
No religion
Jewish
Any other religion or belief
Buddhist
Muslim
Prefer not to say
Christian
Sikh
Hindu
Spiritual
Gay man
Prefer not to say
Gay woman/lesbian
Heterosexual/straight
Sexual Orientation
What is your sexual orientation?
Bisexual
Other
Disability
The Equality Act 2010 states that a disabled person is someone who has a physical or mental impairment which has a substantial, adverse and long-term (usually
12 months or greater) effect on their ability to carry out their day to day duties. If your impairment would have a substantial effect on you without medication
then this part of the definition would be satisfied (this excludes glasses or contact lenses). Please note that cancer, HIV, multiple sclerosis, are automatically
classed as a disability from the day of diagnosis.
Do you have a disability?
Y
N
The University is required by the Higher Education Statistics Agency (HESA), to collect information from staff on the nature of their disability. The following list
has been drawn up by HESA and provided to all universities to ensure consistency of data collection.
If you indicated Yes to the disability question above, please select at least one disability from the options below.
Blind or serious visual impairment
Mental health condition (eg depression or schizophrenia)
Cognitive impairment (eg autistic spectrum disorder or resulting from a head
injury)
Physical impairment or mobility (eg use of arms or using a wheelchair or
crutches)
General learning disability (such as Downs syndrome)
Other type of disability
Long-standing illness (eg diabetes, epilepsy, cancer, HIV, or chronic heart
disease)
Prefer not to say
Deaf or serious hearing impairment
Specific learning disability (such as dyslexia or dyspraxia)
This information is confidential, however, in order to ensure that appropriate reasonable adjustments and support are
in place to assist you in your role, do you agree to meet with your line manager and HR Advisor for your department, to
discuss support mechanisms
Yes
No
If responding Yes a meeting will be organised by the HR Adviser for your department.
May 2016
HESA DATA
Employee
Number
Department
Surname (as official documents)
As part of its statistical reporting the University must make annual returns to HESA (Higher Education Statistics Authority).
To assist in the reporting of this data could you PLEASE TICK below the statements that applies to you
Previous employment – Please tick the entry that describes your previous employment status
Another Higher Education Institute in the UK.
Please provide the name of the institution:
HEI in an overseas country
02
Student in UK
01
07
Private industry/commerce in UK
12
Other education institution
in UK
Other education institution
in an overseas country
Research institution in UK
03
Student in an overseas country
08
Self-employed in UK
13
04
09
Other employment in UK
14
05
NHS/General medical or dental practice in
the UK
Health services in an overseas country
10
Other employment in an overseas country
15
Research institution
overseas
06
Other public sector UK
11
Not in regular employment
21
Previous qualification – Please tick the entry that describes your highest qualification
Doctorate
01
Other Higher Degree
02
PGCE
03
Other Postgraduate Qualifications (in professional)
09
First Degree
11
First Degree with Qualified Teacher Status (QTS)
12
Current academic teaching discipline 1 – If you will be doing
teaching or doing research work, please indicate the academic
discipline that covers your primary subject area.
Other qualifications at first degree level inc professional
19
______________________________________________
Diploma of HE
21
HND/HNC
22
Current academic discipline 2 – If you will be working in more than
one subject area, please indicate the secondary discipline here.
Other undergraduate qualification (inc professional)
29
________________________________________________
A level, Scottish Higher or equivalent (NVQ/SVQ 3)
31
O level /GCSE or equivalent (NVQ/SVQ 2)
32
Other qualifications
97
No qualifications
98
Academic teaching qualification - Please state if you have any
teaching qualifications or have been recognised in other ways for
your teaching experience regardless of your current position.
_____________________________________________
Guidance to the Personal Record Form Data Collection
The University is proud of its diverse community, students and visitors, and is committed to maintaining its excellent record in teaching and research by ensuring
there is equality of opportunity for all, fostered in an environment of mutual respect and dignity. The University takes steps to ensure that all data is treated
sensitively and will not be revealed to third parties. The University is committed to equality and diversity and requires information to comply with its legal
obligations, evaluate its single equality scheme and ensure that the needs of individuals are met. We are also required, by the Higher Education Statistics
Agency (HESA), to collect information from all staff on the nature of any disabilities. The lists on this form have been drawn up by HESA and provided to all
universities to ensure consistency of data collection.
Please note that this data is confidential and will be used for monitoring purposes only. If you have a disability and require any adjustments or have other
queries, please contact your manager or your link Human Resources Adviser.
May 2016