FORM PD94
STARTER FORM FOR NEW EXTERNAL EXAMINERS (UNDERGRADUATE)
Any individual paid by claim by the University must complete a starter form giving essential information required for payment , tax and equality and diversity monitoring purposes. No payments can be made where a starter form has not been submitted. The starter form must be counter-signed by an authorised manager of the University. The form will be returned to you if essential information (marked *) is omitted: this is required for tax purposes and we cannot pay you without this information.
PLEASE COMPLETE SECTIONS A to D IN BLOCK CAPITALS AND SIGN THE DECLARATION IN SECTION E THEN PASS THE
COMPLETED FORM AS INSTRUCTED.
SECTION A: INFORMATION ABOUT YOU
* Family Name * Title
* Forename(s) *Phone Number
* UK Home Address Work Address
*Email
National Insurance Number:
Follow this link if you do not have a National Insurance Number 1
SECTION B: INFORMATION ABOUT CURRENT/PREVIOUS WORK AT THE UNIVERSITY
* Do you have any other current or previous employment at the University? Yes No
If yes, please state your person/employee/payroll number (from pay advice)
SECTION C: EQUAL OPPORTUNITIES INFORMATION
As part of its commitment to equal opportunities, the University monitors its workforce by sex, ethnicity, disability and nationality. In addition, the University is under a statutory obligation to provide certain information to the Higher Education Statistics Agency (HESA) anonymous basis) about the individuals who work for the University. Further information is available on the University website under
HR management of information 2 . To assist with this monitoring, please complete the information below. (The categories for ethnic origin and type of disability are prescribed by HESA.)
- - * Date of Birth (DD_MM_YYYY)
* Sex Male
Ethnic Origin (please circle the appropriate box)
ASIAN OR ASIAN
BRITISH
BLACK OR BLACK
BRITISH
OTHER ETHNIC
GROUP
Female
MIXED OTHER
Indian 31 Caribbean 21 Chinese 34
White and Black
Caribbean
White and Black
African
41 White 10
42 Gypsy or Traveller 15 Pakistani 32 African 22
Any other ethnic background
80
Bangladeshi 33
Any other black background
29 Arab
Any other Asian background
39
1
2
http://www.exeter.ac.uk/staff/employment/payandconditions/casual/worker/nationalinsurance/
http://www.exeter.ac.uk/staff/employment/managementinfo/personaldata/
50 White and Asian
Any other mixed background
43
Information refused
49
98

Nationality
Disability
The University of Exeter welcomes people with disabilities and aims to be supportive in their employment. We will be pleased to consider any special requirements, reasonable resources or facilities when working for the University. (Under the Disability
Discrimination Act (DDA) a disability is defined as physical, sensory or mental impairment which has, or had, a substantial and longterm adverse effect on a person's ability to carry out normal day to day activities.)
Are you disabled?
Yes No
Type of Disability (please circle the appropriate box below if you answered YES to the question Are you disabled?)
Specific learning disability (such as dyslexia or dyspraxia)
General learning disability (such as Down's syndrome)
Social/communication impairment (such as
Asperger’s/ other autistic spectrum disorder)
Long-standing illness or health condition (such as cancer, HIV, diabetes, chronic heart disease, or epilepsy)
Mental health condition (such as depression or schizophrenia)
Physical impairment or mobility issues (such as difficulty using arms or using a wheelchair or crutches)
Deaf or serious hearing impairment
Blind or serious visual impairment
Other type of disability
Two or more impairments &/or disabling medical conditions
56
57
58
96
08
51
52
53
54
55
* Name of Bank
* Branch Sort Code Number
* Account Number
* Name on Account
Roll Number (Building Society)
SECTION D: INFORMATION FOR PAYMENT AND TAX PURPOSES
* Branch Name
If you are of pensionable age, please supply Department of Work and Pensions form CA4140
If maximum NI contributions are paid in other employment, please supply Department of Work and Pensions form CA2700
To ensure that you pay the correct amount of tax, please read all the following statements carefully and enter 'X' in the one box that applies to you. Please attach your P45 if you have one or forward this to the Payroll Office as soon as you receive it.
A
This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance or taxable Incapacity
Benefit or a state or occupational pension.
B
This is now my only job, but since last 6 April I have had another job, or have received taxable Jobseeker's Allowance or
Incapacity Benefit. I do not receive a state or occupational pension.
C I have another job or receive a state or occupational pension.
Student Loans:
If you left a course of Higher Education before last 6 April and received your first Student Loan instalment on or after 1
September 1998 and you have not fully repaid your Student Loan, enter 'X' in box D. (If you are required to repay your
Student Loan through your bank or building society account do not enter an 'X' in box D.)
You should now sign the declaration in Part E below. Payslips will be sent to your home address.
SECTION E - DECLARATION
Claimant: I confirm that the information given above is correct.
Date: Signed:

SECTION F - TO BE COMPLETED BY COLLEGE/SERVICE
**Failure to complete this section correctly will result in the form being returned and payment possibly being delayed**
College/Service
I confirm that the above person may be engaged by the University as an External Examiner in a ccordance with the University’s financial requirements and regulations and checks under the Immigration, Asylum and Nationality Act.
Signed: Date:
Print Name: Job Title:
**PLEASE CHECK THAT ALL FIELDS HAVE BEEN COMPLETED IN SECTION F**