BILANS - tax refund form

BILANS - tax refund form

Page 1 of 4

In order to submit your tax refund claim please follow below

procedure

:

(W celu odzyskania zwrotu podatku prosimy)

1. Fill in and sign below tables

. (Wypełnić i podpisać poni sz tabelk )

2. Sign remaining forms in places marked ‘X’

. (Podpisać pozostałe formularze w wyszczególnionych miejscach ‘X’)

3. Send originals to Bilans:

(Przesłać oryginały do firmy Bilans)

o

all application forms signed,

(wszystkie podpisane formularze) o

all relevant payslips and P45/P60 forms

(wszystkie potrzebne

potwierdzenia zarobków oraz oryginały formularzy P45 / P60)

4. Contact us if you have any questions:

(Skontaktować si z nami w razie pyta ) o [email protected]

o www.e-bilans.co.uk o tel. (+44) 742 679 2733 o tel. (+48) 600 899 950

Personal Information

(Dane personalne) Full name (Imi i Nazwisko)

Date of birth (Data urodzin) Nationality (Narodowo ć)

National Insurance Nr (Numer ubezpieczenia) Contact telephone Nr (Numer telefonu) Home e-mail address (E-mail)

Marital status (Stan cywilny) Single ( ) Married ( ) Divorced ( ) Date of marriage (Data lubu)

BILANS - tax refund form

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Your spouse’s date of birth (Data urodzin współmał onka)

Have you ever been self-employed or worked within CIS (Czy kiedykolwiek pracowałe na własny rachunek lub CIS?)

Yes ( ) No ( )

Address in UK (Adres w Wielkiej Brytanii)

Date of arrival in UK (Data przyjazdu do Wielkiej Brytanii) Date of departure from UK (Data wyjazdu z Wielkiej Brytanii)

Address abroad if you have left UK or will be leaving soon (Adres zagranic je eli opu ciłe UK lub je eli wkrótce zamierzasz wyjechać) Passport or Identity number (Numer paszportu lub dowodu osobistego)

Employment history

(Historia zatrudnienia)

No Start date (Data rozpocz cia) Finish date (Data zako czenia)

I attached (Zał czyłem) P45 / P60 /payslips

Employer’s name, business address, phone no and email (nazwa, adres, numer telefonu oraz email pracodawcy)

1. 2. 3. 4. 5.

Have you already claimed tax refund? (Czy odzyskałe juz zwrot

podatku w Wielkiej Brytanii) Yes ( ) No ( ) If yes, for which tax years (Je li tak, to za który rok podatkowy)

Tax refund amount received (Kwota zwrotu)

Form of repayment

(W jaki sposób chcesz, aby podatek został wypłacony) 1. UK bank account (Na konto bankowe w Anglii) Yes ( ) - Bank

- Account holder (Wła ciciel rachunku) - Sort code

- Account number

2. Foreign bank account (Konto bankowe zagranic ) Yes ( ) - Bank

- Branch address

- Account holder (Wla ciciel rachunku) - Account no (IBAN)

- Swift code

BILANS - tax refund form

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- Payable to (Wystawiony na) - Address (Adres)

Statement to the Employer

(Deklaracja do pracodawcy)

Hereby I, ... authorise ‘Bilans – A Puzniak’ to obtain confirmation of my income (Statement of Earnings) and/or P60/P45 and to act as my sole agent in dealing with my income tax refund application. Please send required documentation directly to: Bilans, Flat 3, 449 High Road, London, N22 8JE.

(Ja ni ej podpisany upowa niam Bilans do reprezentowania mojej osoby w sprawach potwierdzenia zarobków, uzyskania formularzy P60/P45 oraz rozliczenia podatkowego. Prosz przesłać wymagane dokumenty bezpo rednio do Bilans).

Date: .

X

...

Signature .

X

...

Terms and Conditions

I confirm that:

1. All information provided by me is true and to the best of my knowledge(Potwierdzam prawdziwo ć podanych informacji dotycz cych mojej aplikacji).

2. I am aware and I consent that HMRC will pay tax refund to ‘Bilans’ and that ‘Bilans’ will deduct 12% commission of the tax repayment amount. (Wyra am zgod na pobranie 12% prowizji przez firm Bilans)

3. In case HMRC sends tax repayment directly to me or any person connected to me I shall pay 12% commission to ‘Bilans’ within 7 days of the receipt of the tax repayment. (W przypadku gdy HMRC wy le zwrot podatku to kogo innego zobowi zuj sie zapłacić firmie Bilans 12% prowizji w ci gu 7 dni od dnia otrzymania zwrotu podatku)

4. In instance when the claim has been submitted to HMRC by ‘Bilans’ and afterward the application is withdrawn by me I will pay 12% commission within 7 days of the date of withdrawal. (W razie wycofania aplikacji przez ze mnie zapłac 12% prowizji firmie Bilans w ci gu 7 dni od daty wycofania aplikacji)

5. I will notify ‘Bilans’ of any additional information that may influence my tax refund application. (W razie nowych informacji dotycz cych mojego zwrotu podatku niezwłocznie poinformuje o tym firm ‘Bilans’)

6. I fully authorize ‘Bilans’ to act on my behalf in respect of obtaining my tax refund. (W pełni autoryzuje firm Bilans w sprawie uzyskania zwrotu podatku)

7. I am aware that ‘Bilans’ reserves the right to decline to process my application. (Bialns rezerwuje sobie prawo do odmowy przetwa ania twojej aplikacji)

8. I understand that ‘Bilans’ neither can guarantee specific time nor amount of tax repayment. HMRC’s assessment shall be ultimate. (Przyjmuj do wiadomo ci, ze firma ‘Bilans’ nie mo e zagwarantować ani czasu ani kwoty zwrotu podatku. Decyzja HMRC jest ostateczna)

Date: .

X

...

Signature .

X

...

BILANS - tax refund form

Page 4 of 4

What to do next?

(Co dalej?)

Send completed and signed all attached forms to Bilans. (Podpisz i ode lij wszystkie zał czone formularze do Bilans)

Bilans – P. Puzniak

ul. Górników 21/4

Krakow

30-819

Polska

E: [email protected] T:(+48) 600 899 950 W: www.e-bilans.co.uk

Bilans – A. Puzniak

Flat 3, 449 High Road

London

N22 8JE

UK

E: [email protected] T: (+44) 742 679 2733 W: www.e-bilans.co.uk

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Leaving the United Kingdom

Tax reference

National Insurance number

Please use these references if you write or call. It will help to avoid delay.

Issued by

Income Tax claim when you have left or are about to leave the UK

P85 HMRC 03/06

Section 1 Residence details

Complete ALL parts of this Section

What is your nationality?

Telephone

To claim tax relief, or repayment of UK income tax, please

• answer all the questions in order, passing over those questions where you are directed to another section • complete Section 6 if appropriate, and Section 7 in all cases, making sure that you sign and date the sections • take a copy of the completed form in case we need to refer you to it, and return the original to the above office.

On what grounds do you claim this nationality?

Which country are you going to?

Give your address abroad if you know it

When did you leave, or when are you leaving, the UK? Enter Day, Month, Year

/

/

How long were you living in the UK before the date you leftor date you intend to leave?

Do you intend to live outside the UK permanently?

Yes No

u

• If ‘No’, do you intend to live outside the UK for a full tax year starting on 6 April after your departure?

– if also ‘No’ to the above, when do you expect to return to the UK?

_/

_/

Will you be visiting the UK while you are living abroad?

Yes No

u

• If ‘Yes’, what periods do you expect to spend in the UK over the next 3 years? Are you leaving the UK to work?

• If ‘Yes’ go to Section 2

• If ‘No’ give your reason for leaving the

UK in the box, and go to Section 3.

Yes No

u

u

What type of job is it?

• Enter your employer’s name and address

– enter the name of your department if you are employed by the UK Government.

Will you be working full-time?

Yes No

u

Do you have a separate contract for your work abroad?

u

• If ‘Yes’ how long is the contract for?

Will any of your work be carried out in the UK?

• If ‘Yes’ give details of the work you will

be doing in the UK.

Yes No

u

Is your work abroad done on a days on/days off rota?

• If ‘Yes’ give details, including where

you expect to spend the days off. Enter the name of the town or city, and country.

Yes No

u

Country Currency

In what currency will you be paid for your work abroad?

Country where (Bank) Account held Currency

Where will you receive your earnings?

If any part of your pay is to be paid through an office or agent in the UK, give the full name and address of the payer.

Name Address

Postcode

Section 3 Accommodation details

Complete ALL parts unless you are directed to another Section

Will you, or your spouse or civil partner, have any accommodation in the UK while you are away?

Yes No

u

Description Address Postcode • If ‘No’ go to Section 4 • If ‘Yes’

– give details of the kind of accommodation it is for example

house, flat, etc., and – enter its address.

If you left the United Kingdom after 5 April 2000, go to Section 4.

Do you own or have you ever owned the accommodation described above?

u

Yes No

• If ‘No’ go to Section 4

• If ‘Yes’ please tick one box to show whether the property is solely owned or jointly owned

Do you intend to return to the property as your sole or main residence within four years of the date of your departure?

Yes No

u

Postcode

Section 4 Further property details

Complete ALL parts unless you are directed to another Section

Will you be receiving rents, premiums, or other income from any property in the UK?

u

Yes No

How much income from letting will you receive each year? Give an estimate if you do not know the precise amount.

l l l £ l l l £

In the year of your departure In the following year

Will you be receiving the income direct either into your UK bank account or overseas?

• If ‘Yes’ give details of the person who will be paying you.

Yes No

u

Name Address

Postcode

Will you be receiving the income through an agent who manages the property for you? • If ‘Yes’ give details of the agent or if

the agent lives outside the UK details of the payer. Yes No

u

Agent/ Payer Address Postcode

/

/

Date agent began managing the property

Section 5 Other details

Answer ALL the questions in this Section

Will you have any other source of income in the United Kingdom after you have left?

• If ‘Yes’ give details Yes No

u

Yes No

u

Name of the insurer Policy number

£ £ £ Do you have life insurance policies that were taken out before 14 March 1984?

Any entitlement to pay premiums net of tax relief may be affected when you move abroad. • If ‘Yes’ give

details of the policy, and all premiums you will continue to pay after leaving the UK

• Did you notify your insurance companies of your date of departure from the UK?

Yes No

u

l l l l l l l l l Premiums

payable in the year to 5.4. • If ‘No’ go to Section 5

• If ‘Yes’ please tick one box to show whether the property is solely owned or jointly owned

Yes No

u

Name of personal pension scheme Contract number

£ £ £ Do you have a personal pension?

• If ‘Yes’ give details of all contributions you will continue to pay after leaving the UK

• Did you notify your personal pension provider of your date of departure from the UK?

Yes No

u

l l l l l l l l l Contributions

Section 6 Repayment claim and payment authority

Complete unless directed to Section 7

Please enter your address in the box below.

Any repayment will be made direct to you at that address unless you tell us otherwise.

If you want your repayment made to a nominee, complete the remaining boxes in this Section as well.

I claim repayment of tax that I may be entitled to for the year ending on 5 April ,

and enclose Parts 2 and 3 of my P45 Details of employee leaving work.

Your address Postcode Name of nominee Postcode Address

Enter the account details where the nominee is

a bank or building society Sort CodeBranch

–

–

Accountnumber

I authorise repayment to be made to the person, bank or building society shown above.

Signature Date

/

/

Section 7 Declaration

You can be prosecuted if you give false information

The information I have given on this form is correct and complete to the best of my knowledge and belief.

Signature Date

_/

_/

Print your full name

Notes

The HMRC website contains information on residence and tax issues that you may find helpful: www.hmrc.gov.uk/cnr If you are leaving the UK to work abroad, and you or your employer require advice about your National Insurance liability contact:

Centre for Non-Residents, Employers Team, Benton Park View, Newcastle Upon Tyne, NE98 1ZZ.

Please enter here a telephone number including dialling code at which we can contact you with any questions.

For use in HM Revenue & Customs office Date Initials

Notice to S/M Personal pensions

Notice to S/A

Notice to P.H.

Life Assurance

Paragraph 14 _{Notice to L.O.}

/ /

/ /

/ /

/ /

If you are being sent abroad by your present employer, any repayment of tax you are due will be dealt with through your employer’s HM Revenue & Customs office, go to Section 7.

Bilans - A Puzniak

Flat 3, 449 High Road

London

N22 8JE

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(+44) 742 679 2733