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Construction Industry Scheme

Payment and deduction statement

Contractor details
Contractor’s name Payment and deduction made in tax month ended
05 MM YYYY

O`Connor Developments
(Midlands) Limited 0 5 0 1 2 0 2 3

Contractor’s address Employer’s Tax Reference

20 Yates Avenue 1 2 0 / M B 8 7 8 4 7
Aston-on-Trent
Derby DE72 2BG

Subcontractor details Gross amount paid (Excl VAT) (A)


Subcontractor’s full name
£ 1 7 0 0 • 0 0
Wayne Winfield

Less cost of materials


Unique Taxpayer reference (UTR)
£ 0 • 0 0
2 2 5 1 6 5 2 7 0 5

Amount liable to deduction


Verification Number*
£ 1 7 0 0 • 0 0
V /
Amount deducted (B)
* Verification number only to be entered where a deduction
at the higher rate has been made.
£ 3 4 0 • 0 0

Amount payable (A-B)

£ 1 3 6 0 • 0 0

Subcontractors - Please keep this document safe

CISOL1_v0_06 HMRC 09/08

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