Tax credits claim 2004 Tax year 6 April 2004 to 5 April 2005

(1)

YOUR PARTNER

Title, enter MR, MRS, MISS, MS, or other title

Surname

First name(s)

Address– leave blank if address is the same. Postcode

House number

Rest of address, including house name or flat number.

Date of birth

National Insurance number. See Notes, page 9 1.5

Y Y Y Y M M

D D 1.4 1.3 1.2 1.1

YOU

Title, enter MR, MRS, MISS, MS, or other title

Surname

First name(s)

Address– leave blank if address is the same. Postcode

House number

Rest of address, including house name or flat number.

Date of birth

National Insurance number. See Notes, page 9 1.5

Y Y Y Y M M

D D 1.4 1.3 1.2 1.1

Filling in this form

• Use the Notesthat came with this form to help you answer the questions.

• Write inside the boxes – use CAPITAL letters and black ink.

• If you make a mistake, please cross it out and write the correct information underneath the box.

• Answer all the questions that apply to you, even if you have provided the information before.

• Leave blank any box that does not apply to you. • Show allamounts in whole pounds only and ignore the

pence. Round down your income to the nearest pound . Round up your child care costs. See Notes, page 19. • Check that the information you give on the form is correct. • Sign and date the declaration on page 12.

Couples

If you are married, or are a man and woman living together as if you are married, you must claim jointly. Decide whose details go in the YOU column and whose in the YOUR PARTNER column – please stick to this throughout the form.

How we pay tax credits

We will pay tax credits into a bank, building society or Post Officecard account. For more information see Notes, page 43.

Tax credits claim 2004

Tax year 6 April 2004 to 5 April 2005

TC600

PART 1 PERSONAL DETAILS

J

O N A

T

H

A N

R

I

C

H

A

R

D

Please make sure that you • do not fold this form.

• do not strike through boxesor write ‘Not Applicable’. • do not send anything with it, unless we have asked

you to do so.

(2)

YOUR PARTNER

Enter a phone number, we may need to contact you. Daytime number in full

Evening number in full – if different

Are you male or female?Put ‘X’ in the appropriate box

Male Female

Are you subject to immigration control? See Notes, page 10

Yes No

Do you usually live in the United Kingdom? See Notes, page 10

Yes No

If No, enter the name of the country where you usually live in the box below.

Enter any other names you use, or have used, when contacting government departments.For example, your maiden name or former married name.

1.10 1.9 1.8 1.7 1.6

YOU

Enter a phone number, we may need to contact you. Daytime number in full

Evening number in full – if different

Are you male or female?Put ‘X’ in the appropriate box

Male Female

Are you subject to immigration control? See Notes, page 10

Yes No

Do you usually live in the United Kingdom? See Notes, page 10

Yes No

If No, enter the name of the country where you usually live in the box below.

Enter any other names you use, or have used, when contacting government departments.For example, your maiden name or former married name.

1.10 1.9 1.8 1.7 1.6

PART 1PERSONAL DETAILScontinued

YOU

Put ‘X’ in the box if you are disabled. See Notes, page 11

Put ‘X’ in the box if you receive Disability Living Allowance (Highest Care Component) or Attendance Allowance (Higher Rate).

1.12 1.11

The rest of this page is about disability and incapacity.

If it applies to you, or your partner if you have one, you may get more tax credit. Read Notes,

page 11 before you fill it in. If you are not disabled or incapacitated, go straight to PART 2.

INCAPACITY AND CHILD CARE COSTS This question is for couples with children only. Put ‘X’ in the appropriate box if you pay an approved child care provider to care for your children because • one of you is incapacitated, see Notes, page 12, or is

in hospital, or in prison, see Notes, page 17, and • the other person works 16 hours a week or more.

Tell us which one of you is incapacitated, is an in-patient in hospital or is in prison.

Put ‘X’ in one box only

You Your partner

1.13

YOUR PARTNER

Put ‘X’ in the box if you are disabled. See Notes, page 11

Put ‘X’ in the box if you receive Disability Living Allowance (Highest Care Component) or Attendance Allowance (Higher Rate).

(3)

CHILD 1 Surname

First name(s)

Date of birth

Put ‘X’ in the appropriate boxes if,

you pay an approved child care provider to care for this child while you are working. See Notes, page 18

you receive Disability Living Allowance for this child. See Notes, page 15

you receive the Highest Care Component of Disability Living Allowance for this child. See Notes, page 15

the child is registered blind (or has been taken off the blind register in the last 28 weeks). See Notes, page 15 2.5

Y Y Y Y M M

D D 2.4 2.3 2.2

If you, or your partner, became responsible for this child on a date other than their date of birth, enter the date you became responsible. See Notes, page 16.

CHILDREN AGED BETWEEN 16 AND 19

If this child is in full time education, put ‘X’ in the box. See Notes, page 16

If this child is registered with your local Careers Service or Connexions Service, please enter the date that the child left full time education. See Notes, page 16

Y Y Y Y M M

D D 2.8 2.7

Y Y Y Y M M

D D 2.6

PART 2 CHILDREN UNDER 19

Give details of children or young people under 19 that you, or your partner

if you have one, are responsible for.

Notes, pages 13 to 14 explain what we mean by ‘responsible’ and which children or

young people to include. For the rest of this form the words ‘child’ and ‘children’ will

also include young people aged 16 to 19.

If you are not responsible for any children under 19, go straight to PART 4.

There is space for details of up to 3 children on this form.

If you have more than 3 children, cut out and fill in the additional children form at the

back of the Notes. Remember to include it when you send this form back to us.

Enter the child’s name as it appears on their birth certificate.

YOU

Child Benefit reference number

If you are receiving Child Benefit, please enter the reference number below. You will find it on any letters about Child Benefit you have received or on your order book if you have one.

C H B

2.1

YOUR PARTNER

Child Benefit reference number

If you are receiving Child Benefit, please enter the reference number below. You will find it on any letters about Child Benefit you have received or on your order book if you have one.

C H B

(4)

PART 2 CHILDREN UNDER 19 continued

CHILD 2 Surname

First name(s)

Date of birth

Put ‘X’ in the appropriate boxes if,

Y Y Y Y M M

D D 2.4 2.3 2.2

CHILDREN AGED BETWEEN 16 AND 19

Y Y Y Y M M

D D 2.8 2.7

Y Y Y Y M M

D D 2.6

CHILD 3 Surname

First name(s)

Date of birth

Put ‘X’ in the appropriate boxes if,

Y Y Y Y M M

D D 2.4 2.3 2.2

CHILDREN AGED BETWEEN 16 AND 19

Y Y Y Y M M

D D 2.8 2.7

Y Y Y Y M M

(5)

PART 3CHILD CARE COSTS – HELP FOR WORKING PARENTS

This PART is about approved child care. Notes, page 18 explain what approved child care is.

You may get help with the costs of an approved child care provider if

• you are a lone parent working 16 hours or more a week,

or

• you are part of a couple

and

– both of you work 16 hours or more a week,

or

– one of you works 16 hours or more a week,

and

the other is incapacitated, an in-patient in hospital or in prison.

If you use more than 2 providers,

cut out and fill in the additional child care provider form at the back of the

Notes. Remember to include it when you send this form back to us.

FIRST CHILD CARE PROVIDER Name of child care provider

Their address Postcode

House or building number

Rest of address, including house or building name

Their phone number –in full 3.3

3.2

3.1 Enter the name of the local authority or other body

(for example, OFSTED) that approved your child care provider. See Notes, page 18

Provider’s registration number, if they have one.

How many of the children named in this claim are cared for by this provider?

Children

What is the average weekly cost of this child care provider? Before you fill in this box use the Notes, pages 19 to 21, to work out your child care costs.

0

•

£

3.7 3.6 3.5 3.4

SECOND CHILD CARE PROVIDER Name of child care provider

Their address Postcode

House or building number

Rest of address, including house or building name

Their phone number –in full 3.3

3.2

3.1 Enter the name of the local authority or other body

(for example, OFSTED) that approved your child care provider. See Notes, page 18

Provider’s registration number, if they have one.

How many of the children named in this claim are cared for by this provider?

Children

What is the average weekly cost of this child care provider? Before you fill in this box use the Notes, pages 19 to 21, to work out your child care costs.

0

•

(6)

YOU

Do you usually work in the United Kingdom? See Notes, page 23.

Yes No

If No, enter the name of the country where you usually work below

How many hours a week do you usually work? If your hours vary from week to week, or you do seasonal work, see Notes, pages 23 to 26.

hours

If you have stopped claiming or will stop claiming • Income Support, or

• Income-based Jobseeker’s Allowance, or • Pension Credit or Minimum Income Guarantee because

in the last three months you started work, or changed your hours so that you no longer qualified for these benefits, or you will start work in the next 7 days, enter the date you started work, when your hours changed or when you are due to start work.

Only fill in 4.4 if you are aged 50 or over. If you received

• Income Support, or Jobseeker’s Allowance, or • Incapacity Benefit, or

• any benefits listed in the Notes, pages 26 to 27 for 6 months or more before

• you started work, or

• your hours changed so that you no longer received the benefit

enter the date you started workor your hours changed

Y Y Y Y M M

D D 4.4

Y Y Y Y M M

D D 4.3 4.2 4.1

If you are an employee,fill in 4.5 to 4.10 on the next page. If you are a self-employed personfill in 4.11 and 4.12. If you are both,fill in 4.5 to 4.12.

This PART is about work.

You, or your partner if you have one, may qualify for

Working Tax Credit if you usually work 16 or more hours a week, are aged 16 or over, and are

responsible for a child or have a disability.

If you are not responsible for a child and do not have a disability, you may still qualify for

Working Tax Credit if you usually work 30 or more hours a week and are 25 or over.

Fill in this part even if you are on sick leave or maternity, paternity or adoption leave from work.

If you (both of you for couples) do not work, go straight to

PART

5.

PART 4WORK DETAILS

If you are an employee,fill in 4.5 to 4.10 on the next page. If you are a self-employed personfill in 4.11 and 4.12. If you are both,fill in 4.5 to 4.12.

YOUR PARTNER

Do you usually work in the United Kingdom? See Notes, page 23.

Yes No

If No, enter the name of the country where you usually work below

How many hours a week do you usually work? If your hours vary from week to week, or you do seasonal work, see Notes, pages 23 to 26.

hours

If you have stopped claiming or will stop claiming • Income Support, or

• Income-based Jobseeker’s Allowance, or • Pension Credit or Minimum Income Guarantee because

in the last three months you started work, or changed your hours so that you no longer qualified for these benefits, or you will start work in the next 7 days, enter the date you started work, when your hours changed or when you are due to start work.

Only fill in 4.4 if you are aged 50 or over. If you received

• Income Support, or Jobseeker’s Allowance, or • Incapacity Benefit, or

• any benefits listed in the Notes, pages 26 to 27 for 6 months or more before

• you started work, or

• your hours changed so that you no longer received the benefit

enter the date you started workor your hours changed

Y Y Y Y M M

D D 4.4

Y Y Y Y M M

(7)

PART 4WORK DETAILScontinued

YOU – EMPLOYED

How many paid jobs as an employee do you have?

Employer’s name.If you have more than one employer, tell us about the job where you work the most hours

Your employer’s PAYE tax reference.

Look on your latest payslip for this, see Notes, page 28.

Your payroll number, if you have one.

Employer’s pay office address Postcode

Building number

Rest of address, including building name

Employer’s pay office phone number in full

4.10 4.9 4.8

/

4.7

4.6 4.5

YOU – SELF-EMPLOYED Your tax reference

You will find this on your tax return

If you have not yet sent us your first tax return, enter the date you started self-employment.

Y Y Y Y M M

D D 4.12 4.11

YOUR PARTNER – SELF-EMPLOYED Your tax reference

You will find this on your tax return

If you have not yet sent us your first tax return, enter the date you started self-employment.

Y Y Y Y M M

D D 4.12 4.11

YOUR PARTNER – EMPLOYED

How many paid jobs as an employee do you have?

Employer’s name.If you have more than one employer, tell us about the job where you work the most hours

Your employer’s PAYE tax reference.

Your payroll number, if you have one.

Employer’s pay office address Postcode

Building number

Rest of address, including building name

Employer’s pay office phone number in full

4.10 4.9 4.8

/

4.7

(8)

YOUR INCOME

Do not include Child Benefit, Child Tax Credit, Working Tax Credit, Pension Credit or

Disability Living Allowance. The Notes tell you what income to include and help you work it out.

Taxable social security benefits received in the year from 6 April 2003 to 5 April 2004. See Notes page 30 for a full list of the benefits to include.

Earnings as an employee from all jobs for the year 6 April 2003 to 5 April 2004.

Enter your total earnings for the year, before tax and National Insurance contributions and other deductions are taken off. Take off certain pension contributions and Statutory Maternity Pay.

Look for the figure usually described as ‘pay’ or ‘taxable pay’ on your P60 Certificate of Pay and Tax, given to you by your employer.See Notes, page 31.

If you had more than one job in the year– one after the other or at the same time – we need information about your totalpay from all of them.

0

•

£

5.3

0

•

£

5.2

PART 5INCOME DETAILS

The amount of tax credits you get depends on your income (both incomes for couples).

Please give income details in boxes 5.2 to 5.6.

However,

if you, or your partner if you have one, get Income Support (other than in the form of a run-on

payment or if your Income Support is taxable), income-based Jobseeker’s Allowance, or Pension Credit,

just put ‘X’ in the appropriate box at 5.1 and go straight to PART 6.

In the rest of this PART give details of your income for the year 6 April 2003 to

5 April 2004. There is no need to include pence in the figures you give

– round

down to the nearest pound.

See Notes, pages 30 to 42 –

If you want more help to work out your income, call the

Helpline. The number is

0845 300 3900

for England, Scotland and Wales and

0845 603 2000

for Northern Ireland.

YOUR PARTNER’S INCOME

Do not include Child Benefit, Child Tax Credit, Working Tax Credit, Pension Credit or

Disability Living Allowance. The Notes tell you what income to include and help you work it out.

Taxable social security benefits received in the year from 6 April 2003 to 5 April 2004. See Notes page 30 for a full list of the benefits to include.

Earnings as an employee from all jobs for the year 6 April 2003 to 5 April 2004.

Enter your total earnings for the year, before tax and National Insurance contributions and other deductions are taken off. Take off certain pension contributions and Statutory Maternity Pay.

Look for the figure usually described as ‘pay’ or ‘taxable pay’ on your P60 Certificate of Pay and Tax, given to you by your employer.See Notes, page 31.

If you had more than one job in the year– one after the other or at the same time – we need information about your totalpay from all of them.

0

•

£

5.3

0

•

£

5.2

YOU

If you are not working (or are working for less than 16 hours a week) and have recently claimed or are receiving any of the following, put ‘X’ in the

appropriate boxes. DO NOT complete if you are due to start work in the next 7 days and will stop claiming any of the following.

Income Support. See Notes, page 29

Income-based Jobseeker’s Allowance

Pension Credit 5.1

YOUR PARTNER

If you are not working (or are working for less than 16 hours a week) and have recently claimed or are receiving any of the following, put ‘X’ in the

appropriate boxes. DO NOT complete if you are due to start work in the next 7 days and will stop claiming any of the following.

Income Support. See Notes, page 29

Income-based Jobseeker’s Allowance

(9)

YOUR INCOME

Company car and fuel, taxable vouchers, and payments in kind– for the year from 6 April 2003 to 5 April 2004.

If you received any of these from your employer, we need to know their total 'cash equivalent'. Look for these figures on

• form P11D, or • form P9D

which your employer should have given you by July 2004. Use the Notes, page 34 to work out the total amount you received.

Income from self-employment

• If you have notsent us a tax return for the year to 5 April 2004 or if your business receives rental income, see Notes, page 36. This explains how to work out your profit from self-employment. • If you havesent us a tax return for the year to

5 April 2004, enter your total Net profits, minus the gross amount of any contributions made to a pension scheme. See Notes, page 36.

If you made a loss, enter ‘0.00’.

0

•

£

5.5

0

•

£

5.4

YOUR PARTNER’S INCOME

Company car and fuel, taxable vouchers, and payments in kind– for the year from 6 April 2003 to 5 April 2004.

If you received any of these from your employer, we need to know their total 'cash equivalent'. Look for these figures on

• form P11D, or • form P9D

which your employer should have given you by July 2004. Use the Notes, page 34 to work out the total amount you received.

Income from self-employment

• If you have notsent us a tax return for the year to 5 April 2004 or if your business receives rental income, see Notes, page 36. This explains how to work out your profit from self-employment. • If you havesent us a tax return for the year to

5 April 2004, enter your total Net profits, minus the gross amount of any contributions made to a pension scheme. See Notes, page 36.

If you made a loss, enter ‘0.00’.

0

•

£

5.5

0

•

£

5.4

OTHER INCOME

If you received any other income from 6 April 2003 to 5 April 2004 that you have not included at boxes 5.2 to 5.5, give details below.

You mustuse the working sheet in the Notes,

page 42, to help you work out the total to be entered in box 5.6. It is made up of any other incomeabove £300, plus the full amount of any Dependant’s Grant and miscellaneous taxable income. See Notes, pages 38 to 42.

For example, if your total other income is £421, only include £121 (£421minus £300). Then add the full amount of any Dependant’s Grant or miscellaneous taxable income. So, if you have £50 miscellaneous income, enter £171 (£121 plus £50).

Other income includes

• gross interest on savings, investments, and dividendsinclude interest from any bank or building society (but not Individual Savings Accounts (ISAs) or other tax-free accounts)

• Social Security pensionsand any other pensions • income from propertyor land in the United Kingdom

that you let (but not if you let a furnished room in your home for £4,250 or less)

• trust income • foreign income • notional income.

Total other income

0

•

£

5.6

PART 5INCOME DETAILS continued

Remember, we need details for the year 6 April 2003 to 5 April 2004.

The Notes, pages 30 to 42 explain how to work out your annual income and tell you how to

contact us if you need more help.

ESTIMATED INCOME

When you, or your partner if you have one, fill in this form you may not have all the information you need to give us about your income. If any of the amounts shown at 5.2 to 5.6 include estimates, we need to know. See Notes, page 42.

Have you, or your partner used estimates when working out the income shown in boxes 5.2 to 5.6? Put ‘X’ in one box only

Yes No

(10)

WORKING TAX CREDIT

Working Tax Credit is paid to a person who works.

If you are responsible for a child or have a disability, you may qualify for Working Tax Credit if you are aged 16 or over and you usually work 16 or more hours a week. If you qualify for the child care element of

Working Tax Credit it will be paid with Child Tax Credit to the main carer. Payment will be made weekly or every 4 weeks depending on the choice you made at 6.1.

If you are not responsible for a child and do not have a disability, you may still qualify for Working Tax Credit if you are aged 25 or over and you usually work 30 or more hours a week.

The method of payment depends on whether you are employed or self-employed

• Employed

Working Tax Credit will usually be paid as part of your pay from your employer. For example, if you are paid weekly, your Working Tax Credit will be paid weekly.

Until we can arrange payment through your employer, we will pay you fortnightly, direct into your account. If, for some reason, we cannot arrange payment through your employer, we will continue paying you direct. But payment will then be weekly or every 4 weeks. So make sure you fill in 6.3, and 6.5 to 6.10 on page 11.

• Self-employed

You can choose whether you want to be paid weekly or every 4 weeks. Working Tax Credit will be paid direct into a bank, building society or Post Officecard account. So make sure you fill in 6.3, and 6.5 to 6.10 on page 11.

Claiming tax credits

If you have children –

fill in the Child Tax Credit section.

If you are working –

fill in the Working Tax Credit section.

If you have children and are working –

fill in

both

the Child Tax Credit and

the Working Tax Credit section.

PART 6 PAYMENT DETAILS

CHILD TAX CREDIT

Child Tax Credit will be paid direct into a bank or building society or Post Officecard account. So make sure you fill in 6.5 to 6.10 on page 11. You can choose whether you want to be paid weekly or every 4 weeks.

Child Tax Credit is paid to the main carer. The main carer is the person mainly responsible for looking after the children.

Couples

Tell us which one of you is the main carer.

Choose how often you want us to pay you Child Tax Credit

Put ‘X’ in one box only.

Weekly Every 4 weeks

Couples only - which of you is the main carer? Put ‘X’ in one box only.

You Your partner

Make sure the person you choose gives account details in the appropriate column on page 11.

6.2 6.1

Choose how often you want us to pay you Working Tax Credit

Put ‘X’ in one box only.

Weekly Every 4 weeks

(Employees– this choice will only apply if we cannot arrange payment through your employer.)

Couples who both work 16 or more hours a week Choose which of you is to receive payment of Working Tax Credit. Put ‘X’ in one box only.

You Your partner

Make sure the person you choose gives account details in the appropriate column on page 11.

(11)

YOU – ACCOUNT DETAILS Name(s) of account holder(s)

Account number

Sort code

Full name of bank or building society

Branch address Postcode

Building number

Rest of branch address, including building name

Building society and former building society accounts. Enter your other account or roll number.

6.10 6.9 6.8

–

6.7 6.6 6.5

Give details below of the bank, building society, or Post Office

card account you want tax

credits paid into.

• You can use an existing account – you will find account details on your cheque book, bank book or statement.

• If you already have a Post Office

card account please refer to your ‘Welcome Letter’. Enter ‘POST OFFICE’ in

box 6.8 and leave boxes 6.9 and 6.10 blank.

•

I

f you do not have an account or want to open a new one for tax credits, or want to open a Post Office

card

account see Notes, page 46.

Couples with children only

If one of you is to receive Child Tax Credit and the other Working Tax Credit, you should

both

give account

details below, even if you want both credits paid into the same account.

YOUR PARTNER – ACCOUNT DETAILS Name(s) of account holder(s)

Account number

Sort code

Full name of bank or building society

Branch address Postcode

Building number

Rest of branch address, including building name

Building society and former building society accounts. Enter your other account or roll number.

6.10 6.9 6.8

–

6.7 6.6 6.5

(12)

What to do now

When you have completed and signed the form, please send it back to us in the envelope provided. Please do not fold it. Please do not send anything with it, unless we have asked you to do so.

If you do not have the envelope, send the form to: Inland Revenue Tax Credits, Comben House, Farriers Way, Netherton, L69 1BY APPOINTEE

I have completed this form on behalf of the claimant(s) because

If you give any information you know to be false or incomplete, you may be liable to financial penalties and/or you may be prosecuted.

I declare that the information given on this form is correct and complete to the best of my knowledge and belief. Signature

Date

Y Y Y Y M M

D D

YOUR PARTNER

If you give false information or do not tell us about any part of your income, you may be liable to financial penalties and/or you may be prosecuted.

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

I understand thatif I am claiming tax credits as part of a couple, this is a joint claim, so

• we share responsibility for the information given, and • any tax credit overpaid may be recovered from both or

either of us. Signature

Date

Y Y Y Y M M

D D YOU

If you give false information or do not tell us about any part of your income, you may be liable to financial penalties and/or you may be prosecuted.

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

I understand thatif I am claiming tax credits as part of a couple, this is a joint claim, so

• we share responsibility for the information given, and • any tax credit overpaid may be recovered from both or

either of us. Signature

Date

Y Y Y Y M M

D D

APPOINTEE ACTING ON BEHALF OF CLAIMANT(S)

Full name

(including title Mr/Mrs/Miss/Ms or other title)

Address Postcode

House number

Rest of address, including house name or flat number

Phone number – in full

Only complete this section if you have filled in the form for the

person(s) named on page 1 because they are unable to do so

themselves.

See Notes, page 47 to find out who can act as an appointee.

You (both of you in the case of couples) must sign the declaration.

DECLARATIONS