Tax Return Questionnaire

By completing this questionnaire you are providing details to your accountant to enable them to prepare your Self Assessment tax return. Whilst we have information relating to the income you take from your Limited Company we are unaware of any other sources.

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

Feel free to use Section C: Additional Information at the end of the questionnaire for any other information you think we may need to know.

Name
Company Name
Email Address

Notes: Please enter details for the year from 6/4/12 to 5/4/13. Please also provide supporting documentation as necessary, i.e. P60, interest certificates, dividend vouchers etc.

Section A: Income

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

Other Employment within the tax year outside of your own Ltd Company

YesNo

Please provide details from P60’s and P45’s of all salary and tax deducted during the course of the tax year apart from the salary taken from the company for which we act

Primary Employment – Details

Name, Address and PAYE Reference of Employer	Earnings per P60/P45	Tax Paid per P60/P45

Add another

During the tax year period as shown above please confirm if you have received any redundancy payments.

YesNo

Please provide details of any redundancy/severance pay received in the tax year, as well as that received in the previous tax year, if you received a split payment from the same employer. Please include any bonuses received after P45 was produced.

Redundancy

Name, Address and PAYE Reference of Employer	Amount Received	Tax Paid (if any)

During the tax year period as shown above please confirm if you had access to a company car by way of any employment.

YesNo

Benefits in Kind

Car Benefit

Make/model

Engine type/size

Original List Price

Value of Accessories

Contribution towards costs

Date First Registered

Registration No

Business Mileage

Dates Available in the Tax Year

CO2 Emissions

During the tax year period as shown above please confirm if you have received any other benefits in kind from any employment.

YesNo

Benefits and Expenses

If you received any benefits (i.e. medical insurance, mileage allowance) while doing your job please provide details below.

Description of Expense	Value of Benefit

If you have more than one employer please provide details using a separate sheet of paper.

Please state the amount of Tax paid on benefits in kind from your previous employment?

Income from any period of Self Employment during the Tax Year

YesNo

Income from Self-Employment or Partnership

Details of self-employed income or partnership income will be required for the accounting period falling within the tax year 6/4/12 to 5/4/13. Please supply accounts in respect of any of these activities unless we have already prepared or will be preparing accounts.

Did you receive any State Benefits?

YesNo

Social Security Benefits

Please provide details of jobseeker's allowance, supplementary benefit/income support, incapacity benefit, widowed parent's allowance, bereavement allowance, invalid care allowance and industrial death benefit.

Social Security Benefits

Was your total income (from salary, dividends etc.) more than £50k in this tax year?

YesNo

Are you or your partner receiving child benefit?

YesNo

How many children did you receive child benefit for during the period 7th January 2013 to 5th April 2013?
Enter the total amount of Child Benefit received from 7th January 2013 to 5th April 2013.
If you have to pay a charge in relation to child benefit for the April 13/14 tax year, would you like to use your April 2013/14 PAYE Tax Code to collect that tax during the year? Please note that you can only select this option if your salary for the year is above the personal allowance.
YesNo

Did you receive any Pensions during the Tax Year?

YesNo

State Pension and Other Pensions

If you receive a state pension or other pension please provide details.

Pension Provider	Reference	Gross Amount	Tax Deducted	Net Pension Received

Personal Bank/Building Society interest received net of tax

YesNo

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.

Savings Income (interest from banks and building societies)

Please provide details of net interest received and tax deducted from savings related investments, i.e. National Savings, Bank/Building Society Accounts, Government Securities, Purchased Life Annuities etc. If the interest has been received without tax being deducted please just show the gross amount of interest.

Source of Income	Date Received	Net income	Tax Deducted	Gross Income

Dividends received from any Company other than your own Ltd Company

YesNo

Dividend Income

Please provide details of dividends received from shareholdings together with a note of the name of the company, number of shares held. Please provide dividend vouchers as supporting documentation. You do not need to provide details in relation to the company which we advise you on.

Description & Number of Shares Held	Date Received	Net Amount Received	Type of Share

Add another

Rental Income

YesNo

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

Land and Property

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

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

Name and address Total Rent Received Mortgage Interest Letting Fees Insurance Repairs and Renewals Other Costs* *Other Costs – provide details Is the property Furnished and Claiming Wear & Tear Allowance Is this a Holiday Rental?

Add another

Do you have any Foreign Income?

YesNo

Foreign Income

If you have received any income from a foreign source please provide details below.

Country Income Received from	Type of income e.g Dividends/Rent	Amount Received	Tax Paid

Did you have any Capital Gains in the period?

YesNo

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 purchases or sale costs. This does not include any company assets, main residence, motor vehicles, or assets with a value of less than £6,000.

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

Item Sold	Proceeds	Associated Costs of Sale	Cost	Associated costs of Purchase	Date of Purchase	Date of Sale

If you received a tax refund from HMRC for personal tax overpaid, please enter the amount you received and the tax year the refund relates to?

Amount TAX year

Section B: Reliefs & Deductions

Please enter the details of any outgoings for which you would wish to claim tax relief, for example, give as you earn, alimony or maintenance paid (only if born before 6.4.35), gift aid contributions or covenanted payments to charities, payments in respect of venture capital trusts and enterprise investment scheme payments

Did you make any Personal Pension Contributions into a registered UK or overseas pension during the tax year?

YesNo

How much was deducted, if any from your pay after tax?
Please do not enter pension contributions made by your company. If you were a high rate tax payer and paid into a pension scheme, please enter the personal contributions you made during the tax year.

Did you make any Gift Aid Payments to Charity during the Tax Year?

YesNo

Deeds of Covenant/Gift Aid Payments

Please provide details of amounts paid to charity

Payee	Amount Paid

Do you have a Student Loan?

YesNo

Student Loans

Please note student loans are repayable once total income including dividends exceeds £15,000 per annum

Date Loan Commenced	Amount of Outstanding Loan

Did you make any Student loan contributions in the year?

YesNo

Amount of contributions

Section C: Residency Questionnaire (optional)

To be completed by clients who arrived or left the UK during the tax year

Please state your country of birth.
Please confirm the date you arrived in the UK.
From the date you arrived, please confirm whether your intention was to remain in the UK for a period of two years or more?
If you have permanently moved to the UK during the April 2012/13 tax year, please confirm the date you left the country.
Please state the number of days spent in the UK during 2012/13.
Please confirm if you are in receipt of income from another country other than the UK. If so please provide details of income received.

Section D: Additional Information

Please enter below any other information concerning your income, reliefs or allowances which you feel may be relevant to your Tax Return. Please enter 'none' if there are no such items.

Declaration

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

You may be contacted for further information

When you submit this form a copy will be sent to your dedicated accountant and a confirmation email will also be mailed to you to acknowledge receipt.

Submit

Thank you

Your form has been sent

Tax Return Questionnaire

Personal Details

Section A: Income

Other Employment within the tax year outside of your own Ltd Company

During the tax year period as shown above please confirm if you have received any redundancy payments.

During the tax year period as shown above please confirm if you had access to a company car by way of any employment.

During the tax year period as shown above please confirm if you have received any other benefits in kind from any employment.

Please state the amount of Tax paid on benefits in kind from your previous employment?

Income from any period of Self Employment during the Tax Year

Did you receive any State Benefits?

Was your total income (from salary, dividends etc.) more than £50k in this tax year?

Are you or your partner receiving child benefit?

Did you receive any Pensions during the Tax Year?

Personal Bank/Building Society interest received net of tax

Dividends received from any Company other than your own Ltd Company

Rental Income

Do you have any Foreign Income?

Did you have any Capital Gains in the period?

If you received a tax refund from HMRC for personal tax overpaid, please enter the amount you received and the tax year the refund relates to?

Section B: Reliefs & Deductions

Did you make any Personal Pension Contributions into a registered UK or overseas pension during the tax year?

Did you make any Gift Aid Payments to Charity during the Tax Year?

Do you have a Student Loan?

Did you make any Student loan contributions in the year?

Section C: Residency Questionnaire (optional)

To be completed by clients who arrived or left the UK during the tax year

Section D: Additional Information

Declaration