Please complete the Self-Assessment Questionnaire below:

Name*
Company Name*
Email*
Date of Birth*
National Insurance*
Unique tax reference (UTR)*
Tax Year*


Income

During the tax year selected above please confirm your sources of income:


Employment from your own Limited company YesNo
Please provide Gross salary,and Tax paid
Employment from outside of your own Limited company YesNo
Please provide Gross salary, Tax paid, and any benefits received
Dividends received from your own Limited Company YesNo
Please provide the amount of dividends received
Dividends received from outside of your own Limited Company YesNo
Please provide the amount of dividends received as well as the source
Personal Bank/Building Society Interest received gross of tax YesNo
Please provide the amount of interest received as well as the source
Social Security Income YesNo
Please provide the amount of social security received as well as the source
Rental Income YesNo
Please provide the amount of income received as well as the expenses incurred
Capital Gains YesNo
Please provide the proceeds as well as the associated costs
Trading income YesNo
Please provide the sales as well as the expenses relating to this trade
Child Benefit (Paid to you or your partner) YesNo
Please provide the amount received as well the number of children


Deductions and Claims

During the tax year selected above please confirm details for the below:


Personal Pension Payments (Payments made outside of your Limited Company) YesNo
Please provide the amount paid as well as the source
Charitable donations (Payments made outside of your Limited Company) YesNo
Please provide the amount paid as well as the source
Student Loans (Do you currently have a student loan outstanding) YesNo
Please provide further information below
Scottish rate taxpayer YesNo
Any further information YesNo
Please provide the details below


Declaration*

*I confirm that the above questionnaire is complete to the best of my knowledge.