Contact details
First name	First name	Surname	Surname
Title	Title	Middle names	Middle names
Full contact address	Address	Postcode	Postcode
Country of residence	Country	Nationality	Nationality
Mobile number	Mobile	Alternative phone number	Other phone (optional)
Email address	Email address	How do you identify your gender?	Gender
Date of birth	Day	Month	Year
Payment details
PPS number (if known)	PPS number
Bank account name	Acc name
Bank name	Bank name
Bank address	Bank address
Bank account number	Acc number	Sort code	Sort code
IBAN number	IBAN
Swift/BIC code	BIC
Consent
By completing this form, and emailing it to NCAD, I agree to NCAD using and storing the information contained on this form for the purpose of remunerating me for my work for NCAD.
Full name	Full name, consent to use information

PLEASE SEND COMPLETED FORM IN WORD TO:

Kilian O’Callaghan, External Examiner Co-ordinator: ocallaghank@staff.ncad.ie

NCAD use only
Head of School authorisation
School	School	Cost Centre	Cost centre
Head of School	Head of School	Date	Date
By completing this section, and sending the completed form to the External Examiner Co-ordinator, I confirm that the external examiner above has been approved by ACCE at UCD and Academic Council at NCAD to extern the following area, within the budget constraints of the nominated cost centre.
Department	Name of Dept (if appropriate)	Programmes	Name of programmes
What levels are the programmes this external examiner externing?	Select level of programme
HR Payroll processing
HR input and checked by	HR staff member	Date
Payroll input and checked by	Payroll staff member	Date

Personal Public Service number, supplied by Department of Employment Affairs and Social Protection, compulsory for Irish residents. Contact ocallaghank@staff.ncad.ie if you wish to apply for a PPS number.