Self Assessment Questionnaire

Please take the time to fill in all applicable fields. Any blank fields will be regarded as "nil".

Please do NOT leave the email field blank, as your email address is required for all correspondence.

Personal Details

Name:


Date of Birth:


Email:(Important - Please do not leave this field blank)


National Insurance Number:


Company:

 

Married Couple's Allowance / Additional Personal Allowance

Spouses Name:

Date of Marriage:

 

Employments

Name of Employer 1:

PAYE Reference 1:

Income Per P60 1:

Tax Per P60 1:

P11D Details 1:

 

Name of Employer 2:

PAYE Reference 2:

Income Per P60 2:

Tax Per P60 2:

P11D Details 2:

 

Name of Employer 3:

PAYE Reference 3:

Income Per P60 3:

Tax Per P60 3:

P11D Details 3:

 

Dividends Received From Your Own LTD Company

Name of Company 1:

Dividend 1:

 

Name of Company 2:

Dividend 2:

 

Name of Company 3:

Dividend 3:

 

Student Loans

Outstanding Loan?:

Date Payment Started:

Date of Last Payment:

 

Child Benefit

Did either you or your partner receive child benefit during the tax year?

If you are the higher earner please complete the following fields:

Enter the total amount of Child Benefit received by you and your partner:

Enter the number of children you and your partner received Child Benefit for:

 

Bank / Building Society Interest

Name of Bank / Society 1:

Gross Interest Received 1:

Tax Paid 1:

Net Interest Received 1:

 

Name of Bank / Society 2:

Gross Interest Received 2:

Tax Paid 2:

Net Interest Received 2:

 

Name of Bank / Society 3:

Gross Interest Received 3:

Tax Paid 3:

Net Interest Received 3:

 

Name of Bank / Society 4:

Gross Interest Received 4:

Tax Paid 4:

Net Interest Received 4:

 

Name of Bank / Society 5:

Gross Interest Received 5:

Tax Paid 5:

Net Interest Received 5:

 

UK Dividends and other Taxed Interest

Name of Company 1:

Date of Payment 1:

Dividend (£) 1:

 

Name of Company 2:

Date of Payment 2:

Dividend (£) 2:

 

Name of Company 3:

Date of Payment 3:

Dividend (£) 3:

 

Name of Company 4:

Date of Payment 4:

Dividend (£) 4:

 

Name of Company 5:

Date of Payment 5:

Dividend (£) 5:

 

Personal Pension Payments - Payments Made Personally

Provider 1:

Contract Number 1:

Amount Paid 1:

 

Provider 2:

Contract Number 2:

Amount Paid 2:

 

Pensions Received

Name of Company 1:

Reference 1:

Gross Amount 1:

Tax Deducted 1:

Net Pension Received 1:

 

Name of Company 2:

Reference 2 :

Gross Amount 2 :

Tax Deducted 2:

Net Pension Received 2:

 

Social Security Income

Type 1:

Amount Received 1:

 

Type 2:

Amount Received 2:

 

Social Security Income - Statutory Sick and Maternity Pay

Amount Received:

 

Rental Income

Name / Address of Property 1:

Rent Received 1:

Expenses 1:

 

Name / Address of Property 2:

Rent Received 2:

Expenses 2:

 

Gift Aid

Payee 1:

Amount Paid 1:

 

Payee 2:

Amount Paid 2:

 

Capital Gains

Capital Gains:

 

Business Income

Business Income:

 

Any Other Information

Any Other Information :