Please Complete the Relevant Changes and Sign in Section F)

/ Only complete this form if you wish to amend the personal details we currently hold for you in our Personnel records. The data collected is held on the City of York Council’s Personnel/Payroll Computing System, which is subject to strict access codes in accordance with the Data Protection Act. / EST5
CHANGE OF PERSONAL/BANK DETAILS

PLEASE COMPLETE THE RELEVANT CHANGES AND SIGN IN SECTION F)

SECTION A. PERSONAL DETAILS (To be completed in all cases)

Surname: / Forenames:

Known as:

/ Title: / (please state)
Contract Number (must be entered) / Date of Birth
NI No:
Post title: / Post number:
Department & Place of work: / Date of change:

SECTION B.CHANGE OF BANK DETAILS

THIS WILL BE CHANGED FOR THE NEXT AVAILABLE PAY DATE

New bank details
Bank/Building Society Name / Branch

Account Number

/

Sort Code

/ _ / _
Reference/Roll Number

SECTION C. CHANGE OF NAME & PERSONAL STATUS

New Name Details
Forename
Surname
Title
Personal Status: / Single Married Divorced Separated Widowed

SECTION D. CHANGE OF ADDRESS & PHONE NUMBERS

New Address

First Line
Second Line
Post Code
Tel No. (home) / Tel No. (mobile)

SECTION E. CHANGE OF EMERGENCY CONTACT (New details)

Name / Relationship
Address
Tel No. (home) / Tel No. work) / Mobile No.

SECTION F. EMPLOYEE SIGNATURE

(I declare that the information I have provided on this form is true and correct)

Signed by Employee / Date /
FOR OFFICE USE ONLY
(An SU60 (A) should only be completed if the employee is in the LGPS and the change is in respect of name or address)
In LGPS? Yes No If YES - SU60A completed (date): …………………………
Received ……………………………………………. (to be signed in all cases) Actioned :…………………………….. (to be signed in all cases)

Return address: HR Business Centre, 3rd Floor, Mill House, North Street, York, YO1 6JD