Workplace Parking Discount Scheme

Applicant’s Details
Full name
Home address
Personnel number
Job title
Work telephone number
Workbase location
Car Parking
Car park name
Town
Cost (inc vat) / £
Cheque payable to
Length of permit / (minimum of 3 months and a maximum of 12 months)
Dates when car park permit is required / From (dd/mm/yy):
To (dd/mm/yy):
Registration number:
For Quadrant Court: Surrey County Council will get the permit on your behalf, so it is important that you enter your registration number here.
I hereby apply for the Workplace Parking Discount Salary Sacrifice Scheme and authorise Surrey County Council to reduce my gross salary in accordance with this amount.
I understand that the tax and national insurance exemption apply to this salary sacrifice scheme and that my pension benefits will be unaffected. If I terminate the scheme I understand that tax and NIC exemption will not apply to the outstanding balance.
I agree that if I leave the County Council's employment for any reason, I authorise the Council to deduct a termination fee for the remaining fees outstanding from my final salary and if this is insufficient from any other monies due to me. If the sum outstanding exceeds all sums due to me I further agree to repay any remaining sum notified to me within 14 days of my leaving the County Council's services.
I enclose a copy of the invoice with the application form, from the car park provider.
I have read and understood the terms and conditions (overleaf).
Signed: ...... (Employee) Date:
Authorisation
I have carefully examined the details in this application and the invoice and confirm that these details are correct and that the employee is eligible for the Workplace Car Parking Scheme.
Manager name / Signature / Date:
Terms and Conditions
Note 1. Currently HM Revenue & Customs allow the salary sacrifice scheme to be operated for employees to park at or near the workplace. For further information go to:

Note 2. The minimum period for which a Workplace Parking permit will be granted is 3 months.
Note 3. The payment period is fixed and cannot be changed as the scheme is administered under 3, 6, 9 or 12 monthly payments.
Note 4If you cease employment with the council, the Agreement will be terminated and the tax exemptions available under the Workplace Parking scheme will no longer be available. You will be required to pay the termination fee of any remaining balance due, which will be collected from your final salary. Should this not be possible for any reason, or the outstanding liabilities exceed any remaining fees, the council will require settlement of any outstanding liabilities within 14 days after the date on which your employment ceases.
Note 5 This scheme is available to all staff
Note 6 Surrey County Council is not responsible for any loss or damage to your vehicle
Note 7 Please note that current HMRC regulations allow a salary sacrifice scheme to be operated for parking at or near the place of work. These regulations are subject to change by the HMRC and are not the responsibility of Surrey County Council.
You must ensure that you are completely satisfied with the terms and conditions of the scheme before you commit into this scheme.
Please return this form to:
email:
post:Employee Services/Payroll, County Hall - Room 240, Penrhyn Road,
Kingston-upon-Thames, KT1 2DW
fax: 020 8541 9238
Should you have any problems completing this form contact My Helpdesk on 020 8541 9000 or email:
Employee Services use only
Passed for payment by: Date:

Updated August 2014Page 1 of 2