If you use assistive technology (such as a screen reader) and need a
version of this document in a more accessible format, please email email@example.com.
Please tell us what format you need. It will help us if you say what assistive technology you use.
Complete this form to make a disclosure to HMRC that you (or someone that you are acting on behalf of) have calculated and paid arrears of National Minimum Wage to workers under the National Minimum Wage Campaign.