Name:

Company:

Date of Birth:

Email:

National Insurance Number:

Country:

Please specify "Other" country:

Unique Tax Reference (UTR) - e.g. 1234567890:

Tax Year:

INCOME

During the tax year period as selected above please confirm if you have received personal income from the following sources:

Employment Income (inc. salary received from your own limited company)

(This includes employment where you have previously paid PAYE.)

Please provide employment income details from P60s/P45s, other than from the Limited Company we act for. Please record all relevant information in the boxes below and attach supporting documentation using the attachment field at the bottom of this form.

EMPLOYMENT 1

Name and Address of Employer:

PAYE Reference:

Income per P60 /P45:

Tax per P60 /P45:

Health Insurance:

Company Car:

Pension Payments:

Student Loans:

Other

If this employment began during this tax year please enter date:

If this employment ceased during this tax year please enter date:

EMPLOYMENT 2

Name and Address of Employer:

NOTE: If you complete this box, YOU MUST complete the whole "OTHER EMPLOYMENT 2" section. Otherwise, leave blank.

PAYE Reference:

Income per P60 /P45:

Tax per P60 /P45:

Health Insurance:

Company Car:

Pension Payments:

Student Loans:

Other

If this employment began during this tax year please enter date:

If this employment ceased during this tax year please enter date:

I have more employments, please contact me for details.

Dividends received from your own Ltd Company

Please provide details from P60s, other than from the Limited Company we act for, recording your salary and the tax deducted, and form P11D which shows your benefits and expenses and details of any business miles covered in any company vehicle. Please provide the name and address of your previous employers as well as the PAYE reference for them in the boxes below. Please include any student loan deductions within the other box and state that they relate to student loans.

Please attach supporting documentation using the attachment field at the bottom of this form.

IMPORTANT - We will not complete this part if it is left blank.

DIVIDEND 1

Name of Company:

Net Dividend:

DIVIDEND 2

Name of Company:

Net Dividend:

DIVIDEND 3

Name of Company:

Net Dividend:

DIVIDEND 4

Name of Company:

Net Dividend:

DIVIDEND 5

Name of Company:

Net Dividend:

DIVIDEND 6

Name of Company:

Net Dividend:

DIVIDEND 7

Name of Company:

Net Dividend:

DIVIDEND 8

Name of Company:

Net Dividend:

DIVIDEND 9

Name of Company:

Net Dividend:

DIVIDEND 10

Name of Company:

Net Dividend:

Other UK Dividend Income

Please supply details of dividend income received from any company OTHER THAN your own Ltd Co.

Please attach supporting documentation using the attachment field at the bottom of this form.

DIVIDEND 1

Name of Company:

Date of Payment:

Net Dividend:

DIVIDEND 2

Name of Company:

Date of Payment:

Net Dividend:

DIVIDEND 3

Name of Company:

Date of Payment:

Net Dividend:

DIVIDEND 4

Name of Company:

Date of Payment:

Net Dividend:

DIVIDEND 5

Name of Company:

Date of Payment:

Net Dividend:

Personal Bank/Building Society interest received net of tax

All personal bank account interest must be recorded. Please do not include interest from ISAs. If account held jointly please only include your share of the interest.

Please attach supporting documentation using the attachment field at the bottom of this form.

INTEREST RECEIVED 1

Name of Bank/Society:

Interest Received:

INTEREST RECEIVED 2

Name of Bank/Society:

Interest Received:

INTEREST RECEIVED 3

Name of Bank/Society:

Interest Received:

INTEREST RECEIVED 4

Name of Bank/Society

Interest Received:

INTEREST RECEIVED 5

Name of Bank/Society:

Interest Received:

Pensions Received

Please supply details of P60s for pension income received, including state pension.

Please attach supporting documentation using the attachment field at the bottom of this form.

PENSION RECEIVED 1

Name of Company:

Reference:

Gross Amount:

Tax Deducted:

Net Pension:

PENSION RECEIVED 2

Name of Company:

Reference:

Gross Amount:

Tax Deducted:

Net Pension:

Social Security Income

Please supply details of income received such as jobseekers allowance / maternity allowance/ universal credit. Please note, not maternity allowance received directly from social security.

Please attach supporting documentation using the attachment field at the bottom of this form.

Social Security Income 1

Type:

Amount Received:

Social Security Income 2

Type:

Amount Received:

Rental Income

Please complete details of the rents received and expenses incurred. If a jointly owned property only show your share.

If the income is received from letting of furnished rooms in your only (or main residence), please supply details.

Please attach supporting documentation using the attachment field at the bottom of this form.

Rental Income 1

Name/Address of Property:

Property Furnished

Let Jointly

Share Of Property:

Total Rent Received:

Mortgage Interest:

Letting Fees:

Insurance:

Repairs & Renewals:

Ground Rents & Service Charges:

Water Rates, Council Tax, Gas & Electricity:

Holiday Rental

Others & Details

Rental Income 2

Name/Address of Property:

Property Furnished

Let Jointly

Share Of Property:

Total Rent Received:

Mortgage Interest:

Letting Fees:

Insurance:

Repairs & Renewals:

Ground Rents & Service Charges:

Water Rates, Council Tax, Gas & Electricity:

Holiday Rental

Others & Details

Capital Gains

Please give details of any assets sold during the year. We will require the date of contracts to purchase and sell assets, the cost of purchase and sale proceeds received and details of any associated purchase or sale cost. This does not include any Company assets, main residence, motor vehicles, or assets with a value of less than £6000.

Please give details here if you closed your Limited Company during the tax year including name of company and date of closure.

Please attach supporting documentation using the attachment field at the bottom of this form.

Capital Gains 1

Item:

Proceeds:

Cost:

Date of Purchase:

Date of Sale:

Capital Gains 2

Item:

Proceeds:

Cost:

Date of Purchase:

Date of Sale:

Capital Gains 3

Item:

Proceeds:

Cost:

Date of Purchase:

Date of Sale:

Other details / Associated costs of purchase or sale.

If you have more entries please tick here and we will contact you for details.

Business Income

Includes any self employed activities (not income from your Limited Company). Please supply accounts in respect of any of these activities unless we have already prepared or will be preparing accounts.

Please attach supporting documentation using the attachment field at the bottom of this form.

Child Benefit

Please attach supporting documentation using the attachment field at the bottom of this form.

Please give details of your child benefit during the tax year.

Please also confirm how much child benefit you/your partner received during the previous tax year and how many children this was for?

Please include any additional notes related to your child benefit.

Self-Employment Income Support Scheme Grant (SEISS)

Please attach supporting documentation using the attachment field at the bottom of this form.

Amount received from 1st grant available:

Amount received from 2nd grant available:

Amount received from 3rd grant available:

Incorrect SEISS grant claimed:

RELIEFS AND DEDUCTIONS

During the tax year period as selected above please confirm details for any relief or deductions and claims from the following sources:

Student Loans

Please note Student Loans are repayable once total income including dividends exceeds the threshold applicable for the loan plan you are on.

Please attach supporting documentation using the attachment field at the bottom of this form.

Do you have an outstanding loan?

Which loan plan?

Plan 1

Plan 2

Post Graduate Loan

Will your loan be repaid within next two tax years?

Date Payment Started (if in tax year):

Date Loan Repaid (if in tax year):

Married Couple's Allowance / Additional Personal Allowance

Please attach supporting documentation using the attachment field at the bottom of this form.

Spouses Name:

Date of Marriage:

Personal Pension Payments - Payments made personally

Please forward details of PP payments made. Note that we do not need details of Executive Pension Schemes. Do NOT include any contributions made by the Company.

Please attach supporting documentation using the attachment field at the bottom of this form.

PENSION PAYMENT 1

Provider:

Contract Number:

Amount Paid Net by Yourself:

Pension Payments Deducted from Salary:

PENSION PAYMENT 2

Provider:

Contract Number:

Amount Paid Net by Yourself:

Pension Payments Deducted from Salary:

Gift Aid

Please provide details of amounts paid to charity.

Please attach supporting documentation using the attachment field at the bottom of this form.

GIFT AID 1

Payee:

Amount Paid:

GIFT AID 2

Payee:

Amount Paid:

GIFT AID 3

Payee:

Amount Paid:

GIFT AID 4

Payee:

Amount Paid:

GIFT AID 5

Payee:

Amount Paid:

I need to declare information relating to residency

Residency Information

Please attach supporting documentation using the attachment field at the bottom of this form.

I arrived in the UK this year:

I left the UK this year:

I have not been in the UK during this year:

Are you a Scottish Tax Payer?

If yes, please confirm why.

Please attach supporting documentation using the attachment field at the bottom of this form.

Are you a Welsh Tax Payer?

Payments on Account?

If yes, please provide details.

Please attach supporting documentation using the attachment field at the bottom of this form.

Amount Paid 1:

Date Paid 1:

Amount Paid 2:

Date Paid 2:

I have an underpayment of tax in my tax code. Here are the details:

Any other information

Please also provide any other income or outgoings that you may think relevant in completing your Income Tax Return which may not have been mentioned above including foreign income and gains.

Supporting paperwork / Additional documentation

Please upload supporting paper work or any other additional documentation here. This will be sent to your accountant along with all the data. File Upload 1:

File Upload 2:

File Upload 3:

File Upload 4:

File Upload 5:

DECLARATION

I confirm that the above questionnaire is complete to the best of my knowledge.

You may be contacted for further confirmation. When you submit this form a copy will be sent to the relevant point of contact and a confirmation email will also be sent to you to acknowledge receipt.

SELF ASSESSMENT

Tax Return Questionnaire

Self Assessment

INCOME

EMPLOYMENT 1

EMPLOYMENT 2

DIVIDEND 1

DIVIDEND 2

DIVIDEND 3

DIVIDEND 4

DIVIDEND 5

DIVIDEND 6

DIVIDEND 7

DIVIDEND 8

DIVIDEND 9

DIVIDEND 10

DIVIDEND 1

DIVIDEND 2

DIVIDEND 3

DIVIDEND 4

DIVIDEND 5

INTEREST RECEIVED 1

INTEREST RECEIVED 2

INTEREST RECEIVED 3

INTEREST RECEIVED 4

INTEREST RECEIVED 5

PENSION RECEIVED 1

PENSION RECEIVED 2

Social Security Income 1

Social Security Income 2

Rental Income 1

Rental Income 2

Capital Gains 1

Capital Gains 2

Capital Gains 3

Business Income

Child Benefit

Self-Employment Income Support Scheme Grant (SEISS)

RELIEFS AND DEDUCTIONS

PENSION PAYMENT 1

PENSION PAYMENT 2

GIFT AID 1

GIFT AID 2

GIFT AID 3

GIFT AID 4

GIFT AID 5

Residency Information

DECLARATION