Benefits - certificate of earnings form

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01273 292000
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Form to declare income to the Benefits service when pay slips are unavailable

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To make a claim you must provide two monthly, three fortnightly or five weekly payslips. If you are unable to provide payslips, for example if you get hand written payslips, your payslips have gone missing or you just don’t receive payslips; a Certificate of Earnings form can be provided instead. Certificate of Earnings forms should be completed by your employer as a declaration to prove your income.

This form has been made available in PDF format, so that it can be printed and sent to us by post.

Certificate of Earnings form [PDF 102 Kb]

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