SELF ASSESSMENT

Tax Return Questionnaire

By completing this questionnaire you are providing details to your dedicated accountant to enable them to prepare your personal tax return, also known as a self assessment tax return.

Please complete each section of the questionnaire confirming your personal return details. If you have any questions please contact your point of contact.

Feel free to use the 'Any other information' box at the end of the questionnaire for any additional information.

Self Assessment



INCOME

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

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.

OTHER EMPLOYMENT 1



OTHER EMPLOYMENT 2


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



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



DIVIDEND 2



DIVIDEND 3



DIVIDEND 4



DIVIDEND 5



DIVIDEND 6



DIVIDEND 7



DIVIDEND 8



DIVIDEND 9



DIVIDEND 10


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



DIVIDEND 2



DIVIDEND 3



DIVIDEND 4



DIVIDEND 5


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



INTEREST RECEIVED 2



INTEREST RECEIVED 3



INTEREST RECEIVED 4



INTEREST RECEIVED 5



Please supply details of P60s for pension income received.

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


PENSION RECEIVED 1



PENSION RECEIVED 2



Please supply details of income received such as jobseekers allowance / maternity allowance. 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


Social Security Income 2


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



Rental Income 2


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



Capital Gains 2



Capital Gains 3





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.


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:


Please note Student Loans are repayable once total income including dividends exceeds £17,775

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

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



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



PENSION PAYMENT 2



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



GIFT AID 2



GIFT AID 3



GIFT AID 4



GIFT AID 5




Residency Information

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



If yes, please confirm why.

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



If yes, please provide details.

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






DECLARATION

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.


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