Seafarers Employed/Individual Step 1 of 7 14% Seafarers Tax Refunds*Please select...MrMsMrsMissDrOtherFirst Name*Last Name*Email* National Insurance Number*AB 12 34 56 ADate of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality*Where did you hear about us?*Google AdwordsSearch engineFriendLeafletNewspaper/MagazineYoutubeOtherPlease select one option belowWhen did you arrive in the UK (if applicable)?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920When did you leave the UK (or when are you intending to leave)?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920If you are leaving the UK (or have left) do you intend to return to work in this country during the next 12 monthsyesnoHave you previously claimed for a tax refund?yesnoIf so what Tax Year did you claim?Did you use another agent?yesno Contact DetailsPhone*Address* Street Address City ZIP / Postal Code Please provide UK address even if you have left- it is a HMRC requirement, nothing will be sent there.Overseas Address Street Address City ZIP / Postal Code Work HistoryPlease list your full UK employment history from your date of arrival to present (or date of leaving). If you are from the UK, please list all your employments in the last 4 years. (If you have worked for an agency, only list the agency and not the companies that you were sent to work for).Employers Name*Add employers or agency name hereEmployers Address* Street Address PhoneEmail Date started (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60 Did you receive any company benefits e.g. Car, medical, dental, etcyesnoUpload Files Drop files here or Upload P45/Payslips/Statement of earnings/P60Add another employer yes Add an employerEmployers Name*Add employers or agency name hereEmployers Address* Street Address PhoneEmail Date started (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60 Did you receive any company benefits e.g. Car, medical, dental, etcyesnoUpload Files Drop files here or Upload P45/Payslips/Statement of earnings/P60Add 3rd employer yes Add employerEmployers Name*Add employers or agency name hereEmployers Address* Street Address PhoneEmail Date started (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60 Did you receive any company benefits e.g. Car, medical, dental, etcyesnoUpload Files Drop files here or Upload P45/Payslips/Statement of earnings/P60Add 4th employer yes Add employerEmployers Name*Add employers or agency name hereEmployers Address* Street Address PhoneEmail Date started (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60 Did you receive any company benefits e.g. Car, medical, dental, etcyesnoUpload Files Drop files here or Upload P45/Payslips/Statement of earnings/P60 ExpensesUniform ExpensesHow many years are you claiming for?State the total amount claimed ££1000Tool Expenses and/or specialist clothing allowance:How many years are you claiming for?State the total amount claimed £?Total amount you would like to claim a rebate forWorking from home expenses:How many years are you claiming for?State the total amount claimed £?Total amount you would like to claim a rebate forCar mileage allowance:How many years are you claiming for?State total mileageTotal amount you would like to claim a rebate forAnother expenses or claims:Please add detail of any other expenses or claims here BenefitsPlease supply details of any benefits you have received in the UKBenefit nameDate started claimingDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date stopped claimingDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920P45U or statement of benefits received enclosed?yesno Other incomePlease provide any other information about your income which you think may be relevant. For example, have you had any rental income, etc?Enter any additional information here Terms & Conditions I instruct Taxback to act as my agent. I have provided all the relevant information and certify that it shows a true representation of my personal details and employment history. I agree that any refund shall be made payable to Taxback (if I am applying for the refund service). I agree that should HMRC send payment directly to me, Taxback's commission is due and payable within 14 days of receipt of payment. This contract is binding on both parties until the completion of payment made by Taxback, or fees paid to Taxback. Taxback will charge a commission of 15%. (or £50 minimum charge, whichever is the greater). The claim takes approx 2-4 weeks on average. No refund no fee applies. All "Self-employed", “Self Assessment”, “Non-Resident Landlords” or CIS applicants will be subject to the appropriate rates of commission and/or fixed fees published on the website. Photo ID will be required in due course. The commission rate is exclusive of Value Added Tax. All correspondence, telephone, postal and incidental costs will be paid for by Taxback and are inclusive in the fee. Taxback reserve the right to refuse to process any claim without reason. If you cannot, or do not provide all the relevant documentation, P45's, P60's, Statement of Earnings, CIS Certs, etc Taxback may obtain these on your behalf. Taxback cannot be held responsible for claims that exceed the expected completion time if you; fail to supply a valid National Insurance number; you provide incorrect/insufficient information; you provide incorrect/insufficient documentation and/or there are unavoidable delays caused by HMRC. I am aware that if I do not provide Taxback with the correct information this could delay my refund. None of the above clauses affect your statutory rights. I have read the above contract and agree to the terms and conditions.* I agree Signature*NameThis field is for validation purposes and should be left unchanged.
