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Off-payroll rules (IR35) status determination statement

    Client name:

    Client registered company number:

    Client registered address:

    Client trading address (if different):

    Name, role and contact details of Client contact:

    Assignment to which this status determination statement relates

    Off-payroll worker’s name (where known):

    Intermediary through which the off-payroll worker provides their services to the client via the employment business (if known):

    Assignment description “the Assignment”:

    Date of status determination statement provided by the Client:

    Status determination decision:

    The Client has determined that (Tick as appropriate.):

     The off-payroll rules do apply to the Assignment, i.e. the Assignment is 'Inside IR35' The off-payroll rules do not apply to the Assignment, i.e. the Assignment is 'Outside IR35'

    Reasons for the Client’s status determination decision:

    The Client’s reasons for this status determination are:

    The Client must state how it came to this decision, e.g. Client could include a date stamped PDF of the results from CEST or another review tool or audit:

    PDF upload/attachments



    The Client acknowledges that if it decides that this status determination decision is incorrect, the Client must withdraw this statement and provide another with immediate effect.

    The Client also acknowledges that if the Client’s becomes exempt from Part 2 Chapter 10 ITEPA, the client must withdraw this status determination statement.



    Signature:


    Name:

    Email Address:

    Position at Client:

    Date:



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