Beta This part of GOV.UK is being rebuilt – find out what this means

HMRC internal manual

Compliance Operational Guidance

From
HM Revenue & Customs
Updated
, see all updates

Supporting Guidance: employer compliance: guidance by subject: working rule agreements (WRA): example of a lodge certificate (Tax Form A)

This is an example of a Lodge Certificate (Tax form A) for the Heating, Ventilating, Air- Conditioning, Piping and Domestic Engineering Industry WRA. Tax form B can be found at COG930830 

LODGING AWAY FROM PLACE OF RESIDENCE

(Certificate to be signed by the Employee)

I ……………….. (Block Capitals) certify that I am incurring extra expense at my lodging address (as shown on form B) by being employed temporarily away from home and either

I have continuing financial commitments for the maintenance of my dependants (as defined below) at my permanent residence (shown below),

or

I have no dependants (as defined below), but have a continuing financial responsibility for the maintenance of my permanent residence situated within the UK (as shown below) at which I live whilst not working away. My permanent residence is either owned by me (freehold or leasehold) or is a tenanted property, for which, under a written agreement on a commercial basis, I have continuing financial obligations.

I certify that my normal permanent residence is:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

and that my dependants who reside there are:

……………………………………………-………. (wife/husband/civil partner)

……………………………………………………. (dependant child)

……………………………………………………. (dependant child)

I understand that the above information may be checked and that in the event of any particulars being incorrect, lodging allowance will be liable for deduction of income tax.

……………………………………………. Signature of Employee ………………. Date

I, the Employer, certify that to the best of my knowledge and belief, the details set out above are correct.

……………………………………………. Signature of Employer ……………….. Date

WARNING TO APPLICANTS

If you make a false declaration on this form or fail to notify any change in your circumstances affecting the claim you have made above, you may be prosecuted. You may also become liable to pay additional tax and NIC. In you own interests therefore you must notify the site office immediately of any change in your circumstances.

DEFINITION OF DEPENDANTS

  • Definition of dependants who qualify an employee for tax and NIC free lodging allowance.
  • Wife/husband/civil partner with or without dependent child(ren).
  • Dependent child(ren) defined as being below age 18.
  • Common law spouse AND dependent child(ren) living together at a permanent address.
  • Common law spouse (but no dependent child(ren)) provided they have been living together at a permanent address for at least two years.

Note for Office Use

In addition to completing this form, employees are required to sign a form confirming that the payment has been made in accordance with the Regulations.

For this purpose Form B has been produced and is available for order from HVCA Publications. Firms may wish to incorporate Form B into time sheets. If so it is necessary for all the information produced on Form B to be incorporated into the time sheet and identified as ‘Form B’.