Small pension taken as a lump sum:
repayment claim
About this form
Use this form to claim back any tax we owe you on a small pension lump sum payment that you recently received.
If you are not a UK resident for tax purposes you don’t need to complete this form. Instead go to hmrc.gov.uk/international/dta-claim.htm or phone the Taxes Helpline on 0300 200 3300.
What to do now
So that we can make sure we repay the right amount of tax to you, please complete the questions on this form with details of any other income that you expect to receive during the tax year. If you don’t know the final figures give the most accurate estimates you can. Please use whole numbers, rounded down to the nearest pound.
We will make checks at the end of the tax year and contact you if the amount is different. We recommend that you keep a copy of this form until the checks are complete.
When you have filled in this form you should:
sign and date the declaration
attach parts 2 and 3 of all your original forms P45. Your pension provider should have given you this form. We cannot deal with your claim without parts 2 and 3 of the P45.
How to fill in this form
Write inside the boxes, using black ink and capital letters. If you make a mistake, cross it out and write the correct information below it.
If the form is filled in by someone else
If you have asked someone else to fill in the form, or paid a tax adviser to fill it in for you, you are still responsible for the entries on the form and you still need to sign and date the declaration. Phone us on 0300 200 3300 if you have any problems signing the form.
If you are claiming a repayment on behalf of someone else
Please make sure you complete the relevant boxes in the declaration.
A claim can be made on behalf of:
a mentally incapacitated person,
an individual who has granted you the power to act on their behalf.
Claims should be made by:
the person authorised by the courts to look after the affairs of a mentally incapacitated adult (or the Department for Work and Pensions appointee)
an attorney authorised by an ordinary or general Power of Attorney.
More information
If you need help to fill in this form or you need more information you can phone the Taxes Helpline on 0300 200 3300 or Tax Help for Older People on 0845 601 3321 or 01308 488 066. They are an independent charity who provides free tax advice to older people on low incomes.
If you need a large print version of the form please phone the Taxes Helpline on 0300 200 3300.
Your details
Name
Address
Phone number
National Insurance number
Tax year you are claiming for YYYY — YY
Employment income
Do you expect to receive income from paid employment during the tax year you are claiming for?
No Go to question 10
Yes Go to question 7
Give the name of the employer and the amount of your income from this employer before tax is taken off.
Enter your total income from all employments (including any part-time work) before tax is taken off. You should include the income you expect to receive from 6 April to 5 April of the year you received your lump sum payment. If you have more than one job, list each employer and the amount of expected pay from each employer.
Continue on a separate sheet of paper if necessary, adding your name and attach it to this form.
Employer
Amount
in whole numbers, rounded down to the nearest pound
£ £ £ £ £ £ £
6
7
Address
Postcode 1
2
3
4
5
Employment income
Do you receive taxable benefits from this employer?
If you have any taxable benefits such as a company car or medical insurance, you also need to include an estimated figure for these. For more information on taxable benefits go to hmrc.gov.uk/working/bens-shares-tips/benefits.htm No Go to question 10
Yes Go to question 9
Give the name of the taxable benefit and the estimated amount of the taxable benefit.
If you are not sure of the amount of taxable benefit that you are going to receive, you can ask your employer for an estimate of the amount for the year.
Continue on a separate sheet of paper if necessary, adding your name and attach it to this form.
Taxable benefit
Amount
in whole numbers, rounded down to the nearest pound
£ £ £ £ £ £ £
8
9
Self-employment income
Do you expect to make any self-employment profits during the tax year you are claiming for?
No Go to question 12
Yes Go to question 11
Enter the amount of your expected profit from self-employment in whole numbers, rounded down to the nearest pound
Only show profits from self-employment here.
Paid employment should be included in the previous question: Employment income
10 11
UK pension income This includes income from:
a pension from a former employer
a public service pension
a forces pension
a personal pension annuity, and
small pensions paid as lump sums (trivial commutation).
Give State Pension details later in the form under Taxable state benefits.
Do you expect to receive income from any UK pension during the tax year you are claiming for?
No Go to question 14 Yes Go to question 13
12
£
UK pension income
Give the pension payer’s full name, address and the total amount of any UK pension income you expect to receive before tax is taken off.
When entering the lump sum pension payment you’ve received, please only enter the taxable part. The taxable amount will be shown on part 1a of the form P45 that your pension provider gave you.
Continue on a separate sheet of paper if necessary, adding your name and attach it to this form.
Pension payer’s name and address
Amount
in whole numbers, rounded down to the nearest pound
£
£
£
£
£
£
Taxable state benefits
The most common taxable state benefits are:
State Pension including lump sum deferral payments
taxable Incapacity Benefit
Jobseeker’s Allowance
Employment and Support Allowance — only include the taxable element, the part that is based on past National Insurance contributions
Bereavement Allowance or Widow’s Pension
Widowed Parents Allowance or Widowed Mother’s Allowance (excluding any child dependency increase)
Carer’s Allowance — include any amount for a dependant adult, but ignore any for a dependant child
Statutory Sick Pay, Statutory Maternity Pay, Ordinary Statutory Paternity Pay, Additional Statutory Paternity Pay or Statutory Adoption Pay — only include these if we pay you (not your employer), ignore Maternity Allowance, it is not taxable
Industrial Death Benefit Pension — exclude Industrial Death Benefit Child Allowance.
Don’t include:
any addition for a dependant child (but do include any addition for a dependant adult)
the Christmas bonus
the Winter Fuel payment
Attendance Allowance
Disability Living Allowance
Pension credits
Universal credits
any other non-taxable State Benefits.
13
Taxable state benefits
Do you expect to receive any taxable state benefits during the tax year you are claiming for?
No Go to question 16 Yes Go to question 15
Give the name of the taxable state benefit and the total amount of any taxable state benefit you expect to receive before tax is taken off.
Make a separate entry for each different benefit you receive. Continue on a separate sheet of paper if necessary, adding your name and attach it to this form.
Taxable state benefit
Amount
in whole numbers, rounded down to the nearest pound
£ £ £ £ £ £ £
14
15
Taxed interest on UK savings and investment income
As well as bank and building society interest, this can include interest from other deposit takers and interest paid by:
UK authorised unit trusts (AUTs)
open-ended investment companies (OEICs)
National savings and investment products such as fixed rate Guaranteed Income or Growth Bonds
investment trusts
Payment Protection Insurance (PPI) compensation payments.
These investments sometimes pay dividends. If this applies then you will need to answer the questions under Dividends from UK companies. For more information on bank and building society accounts go to
hmrc.gov.uk/taxon/bank.htm
Do you expect to receive taxed interest on UK savings and investment income during the tax year you are claiming for?
No Go to question 18
Yes Go to question 17
16
Taxed interest on UK savings and investment income
Give the name of the interest payer and the total amount of interest received after tax is taken off.
If you have a joint account only enter your share, usually 50 per cent, of the interest received, after tax has been taken off. Continue on a separate sheet of paper if necessary.
Interest payer
Amount
in whole numbers, rounded down to the nearest pound
£ £ £ £ £ £ £
17
Untaxed interest on UK savings
Examples of accounts and products that may pay untaxed interest are:
National Savings and Investment products such as
— Direct Saver
— Easy Access Savings Accounts (EASAs)
— Income Bonds, and
— Investment Accounts
bank and building society accounts and other deposit takers (including where you completed an R85)
interest paid on private loans
interest received on Payment Protection Insurance (PPI) Compensation payments.
You do not need to include tax exempt products such as ISAs. For more information about investments that give a tax-free return go to hmrc.gov.uk/taxon/savings.htm
Do you expect to receive untaxed interest on UK savings during the tax year you are claiming for?
No Go to question 20
Yes Go to question 19
Give the name of the interest payer and the total amount of any untaxed interest you expect to receive.
If you have a joint account only enter your share, usually 50 per cent, of the interest received and only enter interest that will not be taxed before you receive it. If you get interest from National Savings Ordinary Accounts only enter the amount above £70. Make separate entries for each interest payer. Continue on a separate sheet of paper if necessary.
Interest payer
Amount
in whole numbers, rounded down to the nearest pound
£ £ £ £ £
18
19
Dividends from UK companies You might have:
UK company dividends
stock dividends
dividends from UK authorised unit trusts (AUTs)
open-ended investment companies (OEICs)
investment trusts.
For more information on dividends go to hmrc.gov.uk/taxon/uk.htm
Do you expect to receive dividend income from stocks and shares in the tax year you are claiming for?
No Go to question 22 Yes Go to question 21
Give the total amount of dividend income, excluding the tax credit.
Each dividend voucher will show the tax credit and dividend payable. Please enter the total of all dividends you were paid or expect to be paid but do not include the tax credit, in whole numbers, rounded down to the nearest pound.
20
21
Any other income This includes income from:
property
trusts
commissions
tips
foreign income (please give the type of foreign income, for example dividends)
profits paid out on UK life insurance policies – the insurance company should have sent you a chargeable event certificate showing this information, and
any other income that you have not entered anywhere else on the form. Do you expect to receive any other income in the tax year you are claiming for?
No Go to question 24
Yes Go to question 23
Give the source of any other income and the total amount of other income you expect to receive.
Continue on a separate sheet of paper if necessary.
Source
Amount
in whole numbers, rounded down to the nearest pound
£ £ £ £ £ £ £
£
23 22
Gift Aid payments
The Gift Aid scheme is for gifts of money to charities and Community Amateur Sports Clubs (CASCs).
They will ask you to declare that you pay UK tax and then will claim the tax back from HM Revenue
& Customs (HMRC). If you haven’t paid tax equal to the amount the charity or CASC claims back we will include the difference when we work out your repayment. For more information go to hmrc.gov.uk/individuals/giving/gift-aid.htm
Do you expect to make any Gift Aid payments in the tax year you are claiming for?
No Go to question 27 Yes Go to question 25
Enter the total amount of Gift Aid payments you expect to make in the tax year you are claiming for?
You should include regular payments and any one-off payments, in whole numbers, rounded down to the nearest pound. You must also enter the amount of one-off payments again in question 26.
Enter the amount of one-off Gift Aid payment Total amount of one-off Gift Aid payments included in question 25
in whole numbers, rounded down to the nearest pound
25
Pension plans you pay into
Examples of pension plans include Occupational schemes, Personal Pension plans and Retirement Annuity Contracts. Relief is not due on payments made after age 75. For more information on pension plans go to
hmrc.gov.uk/pensionschemes/index.htm
Do you expect to pay into any pension plans in the tax year you are claiming for?
No Go to question 30 Yes Go to question 28
Enter the type of pension plan
Enter the total amount you expect to pay into the pension plan
If the payment is not shown on your payment certificate or pension records ask your pension scheme
administrator for the amount you should enter here, in whole numbers, rounded down to the nearest pound
£
£
£
26
28
29 24
27
Repayment instructions
When we have worked out any repayment due to you, we will send you a cheque. We can send this direct to you at your home address or to your bank or building society account. We can also send it to your nominee or into your nominee’s bank or building society account. We can only pay this into an account held in your name or your nominee’s.
Repayments cannot be made by Bankers Automated Clearing Service (BACS).
Where would you like us to send the cheque?
Your home address Go to Declaration
Nominee’s home address
Go to questions 31 and 32
Your bank or building society
Go to questions 35 to 40
Nominee’s bank or building society
Go to questions 33 to 40
Nominee’s address
Full name of nominee
Address of nominee
Go to Declaration
Your or your nominee’s bank or building society details
Full name of nominee if appropriate
If your nominee is your adviser please enter their reference if appropriate
Name of account holder
Name of bank or building society
Address of bank or building society
Sort code
Account number
Bank or building society roll or reference number if you have one
Go to Declaration
33
34
35 30
36
37
Postcode Address
38
31
39
32
Postcode Address
40
Declaration
I confirm that the information on this form is correct and complete to the best of my knowledge and belief.
I enclose parts 2 and 3 of all P45 forms that I have received for pension lump sum payments.
Full name
Signature
Date DD MM YYYY
If you have signed on behalf of someone else, please give the capacity in which you are signing this form for example, administrator, power of attorney, receiver or trustee
Daytime phone number including area code
What to do next
Please tick this box to confirm that you have enclosed parts 2 and 3 of all forms P45 from your small pension lump sum payments.
Please note: we will not be able to deal with the claim without these forms.
If you have lost or not received your P45 please ask your pension provider for duplicate details before sending in this form.
If the original P45 does turn up, you must not give parts 2 and 3 to any new employer or pension provider because this may affect the amount of tax you pay at the end of the year.
Please check that you have completed all parts of the form that are relevant to you and send it to:
HM Revenue & Customs PAYE & SA
PO Box 4000 CARDIFF CF14 8HR
How we use your information
HM Revenue & Customs is a Data Controller under the Data Protection Act 1998. We hold information for the
purposes specified in our notification to the Information Commissioner, including the assessment and collection of tax and duties, the payment of benefits and the prevention and detection of crime, and may use this information for any of them.
We may get information about you from others, or we may give information to them. If we do, it will only be as the law permits to:
check the accuracy of information
prevent or detect crime
protect public funds.
We may check information we receive about you with what is already in our records. This can include information provided by you, as well as by others, such as other government departments or agencies and overseas tax and customs authorities. We will not give information to anyone outside HM Revenue & Customs unless the law permits us to do so. For more information go to hmrc.gov.uk and look for Data Protection Act within the Search facility.
Your rights and obligations
Your Charter explains what you can expect from us and what we expect from you. For more information go to hmrc.gov.uk/charter