Cashed Out UK Pensions Step 1 of 7 14% Personal*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 EngineFriendLeafletNewspaperMagazineYoutubeOtherWhen 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 monthsyesno Contact DetailsPhone*UK 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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Please state your address overseas if you have left or are leaving the UK. Self AssessmentOnly select those that apply to you Did you receive notification from the Student Loans Company that repayment of an Income Contingent Student Loan began before 6 April 2013? yes Did you receive any foreign income? yes Have you disposed of any chargeable assets, or had any chargeable gains, or you wish to claim an allowable loss, or make any other claim or election? yes Did you receive any interest etc, for example, from UK banks, UK building societies, UK unit trusts? yes Did you receive any dividends, for example, UK companies, authorised unit trusts, open-ended investment companies, foreign companies (up to £300)? yes Did you (or your partner) receive Child Benefit on or after 7 January 2013 (this applies if someone else claims Child Benefit for a child who lives with you and pays you for your child's upkeep)? yes Did you receive any other UK income, for example, employment lump sums, share schemes, life insurance gains? yes Have you made any income tax losses in the year? yes Have you Are you liable to pension savings tax charges or have you received payments from overseas pension schemes? any income tax losses in the year? yes Did you make contributions towards a personal pension or retirement annuity? This does not include payments you make to your employer's pension scheme, which are deducted from your pay? yes Did you give to charity? yes If you, or your spouse or civil partner, were born before 6 April 1935 do you want to claim married couple's allowance? yes Do you want to claim other tax reliefs and deductions, for example, community investment tax relief, venture capital, maintenance / alimony payments? yes Were you party to one or more tax avoidance schemes? yes Are you acting in capacity on behalf of someone else? yes Work HistoryEmployers 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?yesnoe.g. Car, medical, dental, etcUpload files Drop files here or Upload P45/Pasyslip/Statement of earnings/P60Add employer yes Section BreakEmployers 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?yesnoe.g. Car, medical, dental, etcUpload files Drop files here or Upload P45/Pasyslip/Statement of earnings/P60Add 3rd employer yes Section BreakEmployers 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?yesnoe.g. Car, medical, dental, etcUpload files Drop files here or Upload P45/Pasyslip/Statement of earnings/P60 ExpensesUniform ExpensesHow many years are you claiming for?State the total amount claimed £?Total amount you would like to claim a rebate forTool 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 forAny other information please include herePlease add detail of any other expenses or claims hereUpload Files Drop files here or Attach any supporting files here BenefitsPlease supply details of any benefits you have received in the UKBenefit nameDate started claimingDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date stopped claimingDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920P45U or statement of benefits received enclosed? Yes No FileAttach any supporting files here Other incomePlease provide any other information about your income which you think may be relevant. For example, have you had any rental income, etc?Add any other information regarding other income hereTerms & 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.
