| # | | | 5400 | 1260 | 0 | 6 | -1 | Employer's address | 4 | 0
|
|---|
| 1 | | | 2550 | 4520 | 0 | 6 | -1 | - other payments (excluding expenses shown below | 4 | 0 |
| 2 | | | 2650 | 4720 | 0 | 6 | -1 | and lump sums and compensation payments or benefits | 4 | 0 |
| 3 | | | 2650 | 4920 | 0 | 6 | -1 | shown on the following screens) | 4 | 0 |
| 4 | | | 5100 | 5070 | 0 | 6 | -1 | Tax deducted | 5 | 0 |
| 5 | | | 5370 | 540 | 0 | 6 | -1 | Employer's name | 4 | 0 |
| 6 | | | 120 | 1920 | 0 | 6 | -1 | Date finished | 4 | 0 |
| 7 | | | 120 | 1100 | 0 | 6 | -1 | Date employment started | 4 | 0 |
| 8 | | | 120 | 1300 | 0 | 6 | -1 | (only if between 6 April 1996 and 5 April 1997) | 4 | 0 |
| 9 | | | 120 | 540 | 0 | 6 | -1 | Employer's PAYE reference | 4 | 0 |
| 10 | | | 2550 | 4140 | 0 | 6 | -1 | - tips | 4 | 0 |
| 11 | | | 360 | 4140 | 0 | 6 | -1 | * payments not on P60 etc | 4 | 0 |
| 12 | | | 360 | 3660 | 0 | 6 | -1 | * payments from P60 (or P45 or pay slips) | 4 | 0 |
| 13 | | | 60 | 3470 | 0 | 6 | -1 | Money | 4 | 0 |
| 14 | | | 7740 | 3480 | 0 | 6 | -1 | Before tax | 5 | 0 |
| 15 | | | 60 | 5300 | 0 | 6 | -1 | * tax deducted from payments in boxes 1.8 to 1.10 | 4 | 0 |
| 16 | 1 | 1 | 120 | 720 | 0 | 3 | -1 | 1.1 | 28 | 10100001 |
| 17 | 1 | 2 | 5370 | 720 | 0 | 3 | -1 | 1.2 | 28 | 10100002 |
| 18 | 1 | 3 | 120 | 1500 | 0 | 2 | -1 | 1.3 | 4 | 10100003 |
| 19 | 1 | 4 | 120 | 2100 | 0 | 2 | -1 | 1.4 | 4 | 10100004 |
| 20 | 1 | 5 | 5370 | 1500 | 0 | 10 | -1 | 1.5 | 0 | 10100005 |
| 21 | 1 | 6 | 120 | 3040 | 4000 | 4 | -1 | Tick box 1.6 if you were a director of the company | 4 | 10100006 |
| 22 | 1 | 7 | 5080 | 3040 | 3500 | 4 | -1 | and tick box 1.7 if it was a close company | 4 | 10100007 |
| 23 | 1 | 8 | 7155 | 3660 | 0 | 1 | -1 | 1.8 | 4 | 10100008 |
| 24 | 1 | 9 | 7155 | 4140 | 0 | 1 | -1 | 1.9 | 4 | 10100009 |
| 25 | 1 | 10 | 7155 | 4620 | 0 | 1 | -1 | 1.10 | 4 | 10100010 |
| 26 | 1 | 11 | 4530 | 5250 | 0 | 1 | -1 | 1.11 | 4 | 10100011
|
