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TAX RETURN QUESTIONNAIRE

Please complete the form by selecting Yes or No in each section. If you answer Yes in any section, please provide full details and any supporting documents.

Client Name * :

Company (IF APPLICABLE) * :

Employments and Benefits : YESNO

Attach your P60, P45 and P11D here (where applicable) :

Additional Information :

Please confirm if you worked from home :

Self-employment/partnership :YESNO

Business Income :

Business Expenses :

Additional Information :

Business Mileage :

Please confirm if you worked from home :

UK Dividends and Other Distributions :YESNO

Dividend vouchers for shares and unit trusts :

Additional Information :

Interest Received :YESNO

Details for each account held (excluding ISAs) :

Additional Information :

Pensions and State Benefits :YESNO

Details of amounts received (including P60 for private pensions) :

Additional Information :

Property Income : YESNO

Details of income received and expenses incurred in respect of each property :

Additional Information :

Foreign Income : YESNO

Details of any foreign income e.g. interest, dividends, rental income:

Additional Information :

Other Income : YESNO

Details of any other income received in the year e.g. income from a trust or estate, a life assurance policy, share scheme or one-off earnings :

Additional Information :

Pension Contributions :YESNO

If you have made any pension contributions, please provide details (excluding contributions made to employer pension schemes through the payroll) :

Additional Information :

Child Benefit Payments :If you or your partner receives child benefit payments, please provide the amount received in the year and the number of children for whom it is receivedYESNO

Amount Received :

Number of Children :

Charitable Donations :YESNO

Details of amounts paid in the year:

Capital Gains :If you sold any assets in the year, please provide details of date and proceeds of sale, date and cost of purchase and any related expenses.YESNO

Other Outgoings :YESNO

If you made an investment in EIS or SEIS shares or in a VCT, please provide details:

Additional Information :

Student Loan :YESNO

Has the repayment begun? :

Plan Type :

Current Statement :

Residence and Domicile :If you have not lived in the UK throughout the tax year, please provide dates of all arrivals and departures in the tax year.YESNO

Date of Arrival/Departure :

If you are not UK domiciled please confirm whether you have any overseas income that you do not remit to the UK :

Personal Details :YESNO

Address * :

Postcode * :

Telephone Number :

Email Address * :

Marital Status :

Number of Children :

Age of Children :

Please advise if you have set up a time to pay arrangement with HMRC :

Please provide details of a bank account into which any tax refund is to be paid :

Signature :

Date :

Numerii Ltd. – Bookkeeping and Payroll Services

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