TAX RETURN QUESTIONNAIRE
By completing this questionnaire you are providing details to your dedicated tax expert 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.
Name:
Company Name:
Date of Birth:
Sender (Email):
Company Name:
Date of Birth:
Sender (Email):
National Insurance No:
Unique Tax Reference:
e.g. 1234567890
Tax Year:
6 April 2013 to 5 April 2014
INCOME
During the tax year period as selected 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
This includes employment where you have previously paid PAYE.
Yes
If yes, please complete below:
No
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.
Name and Address
of Employer
PAYE reference
Income per P60/P45
Tax per P60/P45
P11D Details
Health Insurance
Company Car
Other
£
£
If this employment ceased during this tax year please enter date:
I have more employments please contact me for details.
NumberMill Ltd, The Mill House, Cardinal Point, Park Road, Rickmansworth, Hertfordshire, WD3 1RE. Tele: 0333 121 2003 Fax: 0333 121 2002.
Email: [email protected], Website: www.numbermill.co.uk. Company Reg No: 9166930. VAT Reg No: 195 554 078
Dividends received from your own Ltd Company
If yes, please complete below:
Yes
No
Yes
No
Yes
No
Yes
No
Please supply details for all dividends received FROM YOUR OWN COMPANY. Remember
to only include your share of the dividends.
IMPORTANT - SJD Accountancy will not complete this part if it is left blank
Name of Company
Net Dividend
£
£
Other UK Dividend Income
If yes, please complete below:
Name of Company
Date of Payment
Net Dividend
£
£
£
£
£
Personal Bank/Building Society interest received net of tax
If yes, please complete below:
Name of
Bank/Society
Interest received
£
£
£
£
£
£
Pensions Received
If yes, please complete below:
Name of Company
Reference
Gross Amount
Tax Deducted
Net Pension
Received
£
£
£
£
£
£
NumberMill Ltd, The Mill House, Cardinal Point, Park Road, Rickmansworth, Hertfordshire, WD3 1RE. Tele: 0333 121 2003 Fax: 0333 121 2002.
Email: [email protected], Website: www.numbermill.co.uk. Company Reg No: 9166930. VAT Reg No: 195 554 078
Social Security Income
If yes, please complete below:
Type
Yes
No
Yes
No
Amount Received
£
£
Rental Income
If yes, please complete below:
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.
Name/Address of
Property
Property Furnished
Yes
Mortgage Interest
No
Letting Fees
£
£
Are you claiming
wear and tear
allowance?
Yes
Total Rent
Received
No
Insurance
£
Repairs &
Renewals
£
£
Let Jointly
Yes
No
Holiday
Rental
Yes
No
Others & Details
Capital Gains
Yes
If yes, please complete below:
No
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.
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
If yes, please complete below:
Yes
No
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.
NumberMill Ltd, The Mill House, Cardinal Point, Park Road, Rickmansworth, Hertfordshire, WD3 1RE. Tele: 0333 121 2003 Fax: 0333 121 2002.
Email: [email protected], Website: www.numbermill.co.uk. Company Reg No: 9166930. VAT Reg No: 195 554 078
Child Benefit
If yes, please complete below:
Yes
No
Please give details of your child benefit during the 2013/14 tax year.
Please also confirm how much child benefit you/your partner received during the 2013/14
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:
Student Loans
Yes
No
Yes
No
Yes
No
Yes
No
Please note Student Loans are repayable once total income including dividends exceeds
£15,000
Do you have an outstanding loan?: Yes
No
Married Couple's Allowance/Additional Personal Allowance
Only relevant if you or your partner were born before 6 April 1935.
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.
Provider
Contract Number
Amount Paid net by
yourself
£
£
Gift Aid
Please provide details of amounts paid to charity.
Payee
Amount Paid
£
£
£
£
£
NumberMill Ltd, The Mill House, Cardinal Point, Park Road, Rickmansworth, Hertfordshire, WD3 1RE. Tele: 0333 121 2003 Fax: 0333 121 2002.
Email: [email protected], Website: www.numbermill.co.uk. Company Reg No: 9166930. VAT Reg No: 195 554 078
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.
11. 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. A printed page is available in your browser should you like to print
a copy of the details submitted for your records.
NumberMill Ltd, The Mill House, Cardinal Point, Park Road, Rickmansworth, Hertfordshire, WD3 1RE. Tele: 0333 121 2003 Fax: 0333 121 2002.
Email: [email protected], Website: www.numbermill.co.uk. Company Reg No: 9166930. VAT Reg No: 195 554 078