PLEASE COMPLETE THIS FORM IN CAPITAL LETTERS USING BLACK INK
CERTIFICATE NO.
P45
INCOME TAX - PAY AS YOU EARN - CESSATION CERTIFICATE
PART 1
Particulars of Employee Leaving
T
Surname of Employee
Employee Address
First Name
PPS Number
Date of Birth
D D M M Y Y
Payroll/Works No.
Employer Registered Number
Date of Cessation
Date of Commencement (if after 1 January)
D D M M Y Y
Mark box x if employee is deceased
Name
Address
and state the name and address of the personal representative of the deceased employee, if known
Mark box x if employee
was on Week 1/Month 1
basis at Date of
Cessation
Mark box x if employee was paid weekly or monthly
Weekly
Monthly
Weekly/Monthly Tax Credit
P
A
Y
E
(a) Total Pay & Tax deducted from 1 January to Date of Cessation
Total Pay
,
. 00
,
,
. 00
,
,
. 00
,
,
. 00
,
Mark box x if
employee was on
emergency basis
at Date of Cessation
Week/Month Number
Weekly/Monthly Cut-Off Point
.
,
D D M M Y Y
.
,
Total Tax Deducted
SAMPLE
.
,
,
(incl. cent)
(b) If employment started since 1 January enter Pay and Tax deducted (or Tax refunded) for this period of employment only
Pay (this employment)
Tax Deducted or Tax Refunded
,
,
Mark box x if
the tax figure at
(b) is a refund
.
(c) Amount of Taxable LUMP SUM PAYMENT on termination included in either pay figure above - if applicable
(d) Total amount of taxable Illness Benefit included in pay figure above - if applicable
Weekly/Monthly USC Cut-Off Point 1
U
S
C
Weekly/Monthly USC Cut-Off Point 2
.
,
Weekly/Monthly USC Cut-Off Point 3
.
,
,
(e) Total Gross Pay for USC purposes & USC deducted from 1 January to Date of Cessation
Total USC Deducted
Total Gross Pay for USC purposes
. 00
,
,
.
.
,
(f) If employment started since 1 January enter Gross Pay for USC purposes and USC deducted (or USC refunded) for this period of employment only
Gross Pay for USC purposes (this employment)
USC Deducted or USC Refunded
Mark box x if the USC
. 00
..
figure at (f) is a refund
,
,
,
P
R
S
I
PRSI - This Employment Only
L
P
T
Total amount of Local Property Tax deducted in this period of employment - if applicable
Total PRSI
,
.
Employee’s Share
,
.
Total number of weeks
of insurable employment
Total number of weeks at Class A
or Subclass “A” in this period
PRSI Classes other than Class A or Subclass “A” in this period
,
.
I certify that the particulars entered above are correct.
Employer
Trade name if different
Address
Date
Phone Number
D D M M Y Y
E-mail
RPC005622_EN_WB_L_1