Full Name

Email

Home Address

Postcode

Employer Name

Contact Tel

Hours per week

Full Time

Part Time

Requested start date January February March April May June July August September October November December

You can pay your total childcare invoice through VSL eliminating the need to make separate payments.
Tax and NI exemptions will be applied up to the maximum of £243 per month or £55 per week.

Value of vouchers

Payment period Please select Weekly Monthly

Basic Rate Taxpayer
Maximum £55 per week or £243 per month

Higher Rate Taxpayer
Maximum £28 per week or £124 per month

Top Rate Taxpayer
Maximum £25 per week or £111 per month

The recommended VSL payment method is an E-Voucher, if any other payment method is preferred, please contact VSL direct.

Please list here all the children for whom you pay/intend to pay for childcare with Voucher Solutions Childcare Vouchers

Name of child

Date of birth

Type of Childcare used

Name of child

Date of birth

Type of Childcare used

Name of child

Date of birth

Type of Childcare used

Please enter the details of the childcare provider you would like to pay with Childcare Vouchers. Please be aware that the person must be registered with Ofsted or the appropriate registering body in your area. If you have joined the scheme but have not yet decided on a carer, you may leave these details blank.

Name of carer

Contact Name

Address

Postcode

Tel

Email

Registration Number

Approval body

Please confirm the type of payment schemes required:

• Direct/Standing order (regular payment made direct to your childcarer)
• Make payments on secure website
• Holding Account /Authorise payment on instructions

Please tick as applicable:

Direct/S.O

Website

Holding

If you, the applicant are accepted to join the scheme it is understood that this constitutes a contractual change to your terms and conditions of employment. You will cease to be entitled to your original salary unless you choose to opt out of the scheme due to a lifestyle change*. Instead of your original salary the childcare vouchers will be deducted from your salary. By submitting this form you are consenting to vary your terms and conditions of employment.

I have read and understood the company Agreement to Vary Terms and Conditions of Employment with regard to Childcare Voucher Solutions Vouchers and agree to abide by its conditions. I undertake to notify the company in writing, if there are any changes in my personal circumstances or childcare arrangements that would cause me to cease being entitled to this scheme.

* A lifestyle change is one that affects your child caring or employment situation.

Clicking I accept means that you agree to the Voucher Systems Limited Terms and Conditions.

I accept