P11D Questionnaire for Year Ended 5th April 2004

Company Name

PAYE Tax Reference

Accounts Office

Individual's Name

Individual's Email Address

National Insurance Number

Position (i.e. Director or Employee)

Motor Vehicles (Company Cars)

Is the individual or his/her family provided with a car (or cars) available for private use? (i.e. private use includes travel from home to work).

If YES, complete an Appendix 1 for each car.

Yes No

Director's Current Accounts and Beneficial Loans To Employees

Have loans been made to, or arranged for, an individual or his/her family? (includes overdrawn Directors current accounts)

If YES, complete Appendix 2.

Yes No

Company Credit Cards

Is a company credit card provided?

Yes No

If YES, please provide copies of the statements for the year with all business expenses highlighted.

Relocation Expenses

Has the cost of relocating an individual exceeded �8,000?

Yes No

If YES, please provide full details of all expenses.

Other Expense Payments and Benefits

Are payments made on behalf of the individual for the following expenses and benefits? Where the answer is YES, please provide the details of the VAT inclusive costs incurred and the contribution by the individual (if any).

Type of Expense or benefit		VAT inclusive costs	Contribution
a. Private Medical Insurance	Yes No
Is the contract with the company or the individual?		Company	Individual
b. Private or home telephone.	Yes No
Is the contract with the company or the individual?		Company	Individual
c. Travel and subsistence.	Yes No
d. Vans made available for private use	Yes No
If YES
Date(s) made available:
Registration No:
Date first registered:
e. Entertaining	Yes No
f. Round sum expense allowances.	Yes No
g. Private subscriptions (i.e. golf club, fitness club etc).	Yes No
h. Use of company assets (i.e. house, villa, Yacht, furniture etc). Where computer equipment was provided, identify the cost separately.	Yes No
i. House, flat or other living accommodation.	Yes No
j. Private or other household bills (i.e. newspapers, repairs, gardener, cleaner, nanny etc).	Yes No
k. Any other benefit identified specifically.	Yes No

Appendix 1

Company Cars

Make and model of car
(i.e. Vauxhall Cavalier GLI 5 door Automatic)

Registration Number

Date first registered

Engine size (cc)

Date(s) Car made available

CO₂ Emission figure (If known)

Manufacturers list price at date of first registration (If known)

Details of accessories fitted:

a) At date of first registration
(i.e. factory-fitted accessories)

b) Since registration, if exceeding £100

Has employee contributed to the cost of the car:

a) Capital contribution

b) Contribution for private use (not fuel)

Fuel

Was Fuel provided for Private Use?

Yes No

If Yes, please provide the following information:

a) Petrol or Diesel

Petrol Diesel

b) Contribution, if any by individual for private fuel. Please state if individual made good the whole cost of private fuel.

Appendix 2

Directors Current Accounts and Beneficial Loans from Company

Name of Director/Employee

Amount outstanding at 5th April 2003

Amount and Date of Advance(s).
If, after 5th April 2003

Amount outstanding at 5th April 2004

Date Loan repaid if before 5th April 2004

Maximum amount outstanding in year

Interest paid by individual

Directors Loan Accounts

If overdrawn, please supply a copy of the ledger account showing transactions for the year ended 5th April 2004

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