P.A.Y.E. Tax Refunds Employed/IndividualStep 1 of 714%P.A.Y.E. Tax Refunds*Please select...MrMsMrsMissDrOtherFirst Name*Last Name*Email* National Insurance Number*AB 12 34 56 ADate of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality*Where did you hear about us?*Google AdwordsSearch engineFriendLeafletNewspaper/MagazineYoutubeOtherPlease select one option belowWhen did you arrive in the UK (if applicable)?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920When did you leave the UK (or when are you intending to leave)?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920If 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?yesnoContact DetailsPhone*Address* Street Address City ZIP / Postal Code 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)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60Did 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 yesAdd an employerEmployers Name*Add employers or agency name hereEmployers Address* Street Address PhoneEmail Date started (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60Did 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 yesAdd employerEmployers Name*Add employers or agency name hereEmployers Address* Street Address PhoneEmail Date started (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60Did 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 yesAdd employerEmployers Name*Add employers or agency name hereEmployers Address* Street Address PhoneEmail Date started (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date left (if known - approx dates if not sure)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enclosed documentation P45/Payslip Statement of earnings P60Did you receive any company benefits e.g. Car, medical, dental, etcyesnoUpload Files Drop files here or Upload P45/Payslips/Statement of earnings/P60ExpensesUniform 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 hereBenefitsPlease supply details of any benefits you have received in the UKBenefit nameDate started claimingDay12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date stopped claimingDay12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920P45U or statement of benefits received enclosed?yesnoOther 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 hereBank NameAccount NumberSort Code/BSBBICIBANBank Address Street Address City ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina 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 Terms & ConditionsI instruct Britbound 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 Britbound Taxback (if I am applying for the refund service).I agree that should HMRC send payment directly to me, Britbound 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 Britbound Taxback, or fees paid to Britbound Taxback.Britbound Taxback will charge a commission of 15%. 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 Britbound Taxback and are inclusive in the fee.Overseas telex transfer cost £30.Britbound Taxback reserve the right to refuse to process any claim without reason.If you can not, or do not provide all the relevant documentation, P45's, P60's, Statement of Earnings, CIS Certs, etc Britbound Taxback may obtain these on your behalf.Britbound 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 Britbound Taxback with the correct information a resubmission fee of £50 may be applicable.None of the above clauses affect your statutory rights.I have read the above contract and agree to the terms and conditions.* I agreeSignature*EmailThis field is for validation purposes and should be left unchanged.
