Application Form for Benefits+ Childcare Vouchers

As childcare costs are normally paid in advance please note that deductions from salary one month are normally paid to Carer at beginning ofthe following month. Orders therefore need to be in advance of requirements.

Ref Note below (*) Not the Caring period but the salary from which deductions will begin, bearing in mind the above note.

(*) SALARY PERIOD: FROM / TO
E.g.:- From: 1/1/09 To: 30/9/09 OR if constant amount From: 1/1/09 To: Until further notice
DATE OF ORDER:
STAFF NO::
NAME:
EMAIL ADDRESS:
WORK TEL NO: / DEPT/DVN
Voucher Value Required / Carer’s name address
(Initial Set-up)
Should the Carer change please use Employers for Childcare ‘Change of Details Parent Form’ to amend this

Please complete your voucher order in block capitals and return to Salaries Office by 7th of the salary month from which the voucher value is to be initially deducted. Changes to the deadlines eg at Christmas/Easter will be advised through the Communications RoundUp

I hereby confirm that in accordance with the agreement to vary the terms and conditions of my employment (the Agreement) of which this confirmation forms part, I will cease to be entitled to my original salary for the period detailed above. Instead I will receive an Adjusted Monthly Salary and childcare vouchers with a value equal to the total amount indicated above.

Under the terms of the Agreement I acknowledge that the employer will satisfy its obligations under clause 3.1.2 of the Agreement by paying to me the Adjusted Monthly Salary and delivering to me the childcare vouchers indicated above.

I hereby declare that I am the parent / guardian for the child / children for whom I am purchasing these vouchers and acknowledge that it is my responsibility to select the individual who will provide childcare facilities to my child / children. Neither Queen’s University of Belfast nor Employers for Childcare has any liability (expressed or implied) for the acts or omissions of such child carer, unless Employers for Childcare failed to check that the child carer is registered under the Children Act of 1989.

This agreement to vary terms & conditions of employment is made between the employee detailed overleaf and Queen’s University Belfast.

It is hereby agreed:

1.Definition

1.1‘Original Monthly Salary’ means the monthly salary of the employee on the assumption that the employee’s terms and conditions of employment had not been varied by this agreement or any similar agreement.

1.2‘Terms’ means the terms and conditions of employment between the employee and the employer.

1.3 ‘Voucher’ means the Employers For Childcare Vouchers Ltd

1.4‘Voucher value’ means the monetary value of vouchers set out in clause 4.

1.5‘Adjusted Monthly Salary’ means the original monthly salary less the voucher value.

1.6‘Variation Term’ means the period of time, being not less than one calendar month for which this agreement is to apply, as set out in clause 6.

.2. Recital

2.1 By this agreement, the employee and the employer agree to vary the Terms.

2.2 Before entering into this agreement, on the assumption that no agreement similar to this agreement had been entered into, the employee would have been entitled to receive the Original Monthly Salary.

2.3As a consequence of entering into this agreement, the employee will be entitled to receive the Adjusted Monthly Salary and Vouchers.

2.4The employee and the employer acknowledge that this Agreement constitutes a notice of a variation to the Terms for the Variation Term in accordance with the provisions of Section 4 of the Employment Rights Act of 1996.

3. Variation

3.1The employee and the employer agree to vary their Terms for the Variation Term as follows:

3.1.1The employee will cease to be entitled to the Original Monthly Salary.

3.1.2The employee will be entitled to receive the Adjusted Monthly Salary and Vouchers with the face value equal to the Voucher Value.

4. Voucher term

4.1For the purposes of this agreement, the Voucher Value (expressed in pounds sterling) to be received under the Terms (as varied by this agreement) shall be as stated on the form which forms part of this agreement which is printed on the reverse hereof (“Order Form”).

5.Statutory Payments Only

5.1Statutory Benefits may not be sacrificed.

6.Variation term

6.1The Variation Term for this variation of the terms shall commence on the first day as notified on the Order Form, and shall expire on the last day as notified on the Order Form.

6.2The employee may opt out of the scheme by notifying the Salaries Office in writing by the 7th of the salary month in which deductions are to be made or by a rescheduled submission date as advised by RoundUp.

7. Responsibility

The employee confirms that he or she:-

7.1.1Is the parent or other legal guardian of the child or children in respect of whom the Vouchers will be used to provide childcare facilities.

7.1.2Is responsible for selecting the individual or institution that will provide such childcare facilities.

Signed
(The Employee)
Date