EMA Employer's Certificate

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					                                               Falkirk Council
                            Education Services - Education Maintenance Allowance
                                    Occupational/State Pension Certificate
                                                   2009-10




 Use this form if your Parent/Legal Guardian does not have an Inland Revenue Tax Credit Award Notice or a P60 for occupational/state pension.
                                       This form should then be returned with your EMA application form.


Pupil Name                                                                                EMA No                EMA/


School Attended



                                                Pension Provider’s Certificate


                                                                                                    Nat Ins/
Name
                                                                                                Employee No

Address




To the Pension Provider - Please provide details of the:

Occupational/State pension start date

TOTAL GROSS INCOME FOR YEAR ENDED
5 APRIL 2009
                                                           £
                                                                                        Provider’s Stamp


                                                                                      Provider’s Signature

                                                                                                       Date