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| Email Address: |
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| Daytime Contact Number: |
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Personal Circumstances
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| Would you please let me have details of any changes in your financial affairs including the opening or closing of bank or building society accounts and of any other changes to your income or outgoings or personal circumstances. |
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Children's Tax Credit
Please let me have the following details of any qualifying children and details of any other person, who, whether living with you or not, is also eligible to claim part or all of the relief during the tax year.
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Do you currently have a child under 16 living with you?
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Yes No |
If Yes, please provide full name & date of birth of each child
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Date of Birth |
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Other Claimant Details
Please provide the following details about the other claimant:
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| Forename |
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| Surname |
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| Address |
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| Relationship to child |
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A qualifying child is one who falls into all of the following three categories:
- Your own child (including a stepchild or adopted child) or a child you look after at your own expense
- Under the age of 16 at the start of the tax year (and whilst living with you)
- Living with you at some time during this tax year
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INCOME |
Employment Income |
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Employement Expenses |
| Details of professional subscriptions and other deductible expenses incurred |
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Pensions Received
Details of state pension and other benefits received |
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Income from trade, profession or vocation (including partnerships) |
| If we do not prepare accounts, please provide copy accounts and computations |
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Pension contributions |
| Details of all premiums paid in the year to 5/4/2004 |
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| Details of Additional Voluntary Contributions made to Employers Pension schemes and a note of amounts contributed by employer to a personal schemes in 2003/04 |
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| Details of pension contributions to be paid in 2004/05 |
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Property/Land |
| Rents Receivable |
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| Premiums Received |
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Expenses Incurred
(please provide a list) |
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Income from Savings and Investments |
National Savings
eg investment account, income bonds etc. |
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| Net interest from banks and building societies (Please also give the name of bank or building society) |
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| Other interest received (Specify payer & whether gross or net) |
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| Dividends from shares in UK companies (Please supply dividend counterfoils) |
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| Stock Dividends (Please supply dividend counterfoils) |
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| Income from UK unit trusts (Please supply dividend counterfoils) |
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Foreign Investment Income |
| Income from savings and investments abroad (Please supply any tax certificates) |
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Income from Trusts and Estates |
| Form(s) R185/R185E |
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Other Income |
| Describe the source, when it first arose, amount received and tax deducted (if any) |
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EXPENSES AND DEDUCTIONS |
Qualifying Loans |
| Certificates of interest paid on loans for business, let property or other qualifying purpose |
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Other Outgoings |
| Gift Aid |
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| Maintenance Payments (If either spouse is born before 6 April 1935) |
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Capital Transactions |
Purchase/Sales of Securities
All contract notes for transactions in year, and details of subscriptions for any new shares |
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Other acquisitions/disposals
Details of any other transactions in the year including share options granted or exercised |
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Other Transactions |
Enterprise Investment Schemes
Venture Capital Trusts
Details of any investments made or sold during the year |
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Gifts and Assets
Names, address of donor and donee, details of assets, date of transfer and any documentation |
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