To be completed by the employee - If this form is received by VPS after the 5th of the month then the information may not be updated until the following month – and payment will have to be made into your existing bank account

Version 1 – 1/11/2014 – CCG/VPS
HR27 – Record of Bank Details
All information will be logged and audited within the organisation. This form should be fully completed.  Incomplete forms cannot be actioned and will be returned to the requestor.  The requestor must be a registered authorised signatory. This form must be received from the registered email address in order to be processed.	
1. About the Employee	
Organisation		
Assignment Number	     	It is essential that this number is provided. It can be found on either the employees wage slip or the monthly budget report	
Surname	     	Forename(s)	     	
Title		Job Title	     	
	
2. Previous Bank Account Details	
Previous Bank Name	     	
Bank Address	     

	Please include post code 	
Account Number	     	This should be 8 digits long	
Sort Code	     	This should be 6 digits in groups of 2 split by a dash e.g. 11-22-33	
Roll Number	     	This is optional – building society accounts often have roll numbers	
	
3. New Bank Account Details	
Effective Date	     	Bank Name	     	
Bank Address 	     

	Please include post code 	
Account Number	     	This should be 8 digits long	
Sort Code	     	This should be 6 digits in groups of 2 split by a dash e.g. 11-22-33	
Roll Number	     	This is optional – building society accounts often have roll numbers	
	
4. Employee’s Declaration	
I authorise you to replace my existing bank details (section 2) with my new bank details (section 3) effective from the date I have provided in section 3.	
Signed	      	Date		
All details should be completed in full on screen and then printed. Please email scanned PDF.file copy to VPS:  CCGWorkflowNotifications@sth.nhs.uk. Please ensure subject field of email includes: VPDxxx, Assignment Number, Employee name, Form HR27
 Or via Post to:
Victoria Pay Services, Coleridge House, Northern General Hospital, Herries Road, Sheffield, S5 7AU REF: VPDxxx