Special Collection Form: End of Year Summary (SC4)

• Published date: 26 April 2021
• Issuer: Department of Social Protection

SC4

Certificate of Pay Related Social Insurance for Year Ended 31st Dec

For employees whose earnings are not assessed for Income Tax under the Irish PAYE syste m

Name of Employee:

PPS Number:

Address:

Payroll/Works No (if applicable):

PRSI in this employment

1. Earnings. ______________

2. Employee’s PRSI. ______________

3. Total (employer + employee) PRSI. ______________

4. Total number of weeks insurable employment. ______________

5. Initial social insurance contribution class. ______________

6. Subsequent social insurance contribution class. ______________

7. Number of weeks at the class entered at line 5 above. ______________

8. Period of employment from DD/MM/YYYY to DD/MM/YYYY

DECLARATION

I declare, for the above-named employee, PRSI contributions have been remitted to the Department

of Employment Affairs and Social Protection in accordance with Social Welfare Regulations.

Employer: __________________________________ (For and on behalf of employer)

Employer Registered Number:

E-mail contact: _________________________

Date: __________________________

TO THE EMPLOYEE THIS IS A VALUABLE DOCUMENT

You should retain this document carefully as evidence of PRSI deducted.

Note: There is a four-year time limit on claiming refunds of PRSI.

You may also require this document as evidence if you need to claim social welfare

benefits within the next two years.

Official Stamp