NES Payroll Guarantee Form

Please ensure that you submit your claim within 14 days of the payment that the claim is related to.

Contractor Name *

Please tell us your name
Limited Liability Company Name *

Please tell us the name of your Limited Liability Company
Type of payroll error? * Late payment Incorrect amount paid Late payment of business expenses Wrong currency
Please tell us the type of payroll error that you're claiming for
Please specify the date that the payment should have been made by NES / DD / MM YYYY
or, please specify the date the incorrect payment was received from NES / DD / MM YYYY
Was your timesheet faxed or emailed to the correct number/ address before the deadline? *
Were your New Starter Contractor Details submitted on time?
Full details of the payroll error *

Please provide a brief explanation of why you're making this claim. Please ensure that your claim complies with the conditions of the guarantee.
Phone number

Please tell us your phone number in case we need to get in touch with you
Your email address *

Please let us know your email address - so that we can confirm receipt of your claim
I confirm that the above statements are true and correct. *