Please answer all questions as fully and as accurately as possible. Please note that any answer that is subsequently found to be incorrect may affect the opinion given on the IR35 status. Confirmation of arrangements Full name of worker to which this information relates*Name of Client organisation (your company)*Full name and job title of individual completing this form*Engagement Start DateDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Engagement End Date (if known)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Has the worker been engaged for the purposes of a specific project?* Yes No If yes, what is the nature of the project?Please provide some brief detail on the services the worker provides*Full name and job title of the individual to whom the worker will report (if not the person completing this form)Which party decides the location at which the work is done?* The worker The client (you) Agreed between worker and client The client’s customer Which party decides the hours at / days on which the work is done?* The worker The client (you) Agreed between worker and client The client’s customer Can you instruct the worker to do other work outside of what has been agreed and specified above?* Yes No Please provide further details if necessaryDo you have the right to instruct the worker in relation to their working methods?*This pertains to the technical manner in which the work is done (rather than outcomes) and does not include the requirement to comply with regulatory or statutory frameworks Yes No If yes, please provide further detailsPlease provide details of any rules, policies or procedures governing your employees that also apply to the worker*E.g. health & safety, data protection, any HR policies or procedures etcPlease provide details on how you keep track of the worker's progress, how frequent this is and whether the work is subject to monitoring or overview*Does the worker have the right to send a suitably qualified substitute, for any reason, to perform their work during the engagement?*By answering “yes”, you confirm that you would not reject any substitute if they have the required skills, qualifications and experience required to perform the services and that the worker’s intermediary would be responsible for paying the substitute Yes No Has substitution ever occurred?* Yes No N/A – engagement has not yet started Does the worker have the right to subcontract or assign elements of the work to another party?* Yes No Are you obliged to provide the worker with continuous work throughout the period of engagement?* Yes No Are you obliged to pay the worker if there is no work available during the period of the engagement, including during any notice period?* Yes No Please provide details of any of their own equipment / facilities the worker will use in the provision of the services*E.g. laptop, software, tools etcIs the worker obligated to compensate you for any damage or loss caused by their negligence?* Yes No Do you expect the worker to rectify any defective work in their own time and at their own expense?* Yes No Do you place any restrictions on the worker working for other customers or clients during the course of the engagement?* Yes No If yes, please provide further detailsIs the worker entitled to any benefits that are available to your employees?*E.g. performance bonuses, paid-for training, holiday/sick pay, overtime, memberships etc. Yes No If yes, please provide further detailsDoes the worker work within a team?* No Yes, contractors / consultants only Yes, client employees only Yes, mix of contractors and employees Other Please provide further details if necessaryDo you have any employees who carry out the same or similar work to the worker?* Yes No If yes, please provide further detailsIs the worker responsible for managing any of your employees* No Project management only Line management Please provide further details if necessaryIf the worker is working / interacting with your customers, how do they represent themselves?* They work for their own business They are an independent contractor acting on your behalf They work for you Not applicable What is the basis of payment?* Daily or hourly rate (time & materials) Fixed price paid on delivery Fixed monthly / yearly fee Commission based Other Please provide further details if necessaryDo you expect the contract will be extended and if so what is the likely duration?*Further InformationPlease provide any further information which may be relevant to this assessmentYour data will be used in accordance with our Privacy Notice
