Tax Questionnaire

Name*

Business Name*

Email*

Signature* (Please enter your initials as your signature)

A fee of £80 plus VAT will be charged if amendments have to be made as the result of incomplete or incorrect information received.

1. INVESTMENT INCOME

1.1 Did you receive any interest on bank or building society accounts during the tax year?

 Yes  No

If yes give details below:-

Please note, we require details from personal savings and deposit accounts only. Do not include business accounts here and do not include Cash ISAs

Accounts opened before 6 April 2010

Name of Bank/Building Society Account Number

Interest Received (06/04/10-05/04/11)

Tax Deducted Received  Net  Gross

For additional Bank Accounts, please follow the previous format

Accounts opened during the tax year

Name of Bank/Building Society Account Number

Interest Received (06/04/10-05/04/11)

Tax Deducted Received  Net  Gross

For additional Bank Accounts, please follow the previous format

1.2 Did you receive any dividends on shares during the tax year?

 Yes  No

If yes give details below:-

Name of Company

Quantity Of Shares Held

Dividends Received(£) (06/04/10-05/04/11)

Tax Credit

For additional Dividends, please follow the previous format

2. INCOME FROM LAND & PROPERTY

2.1 Did you receive any income from renting land or property during the tax year?

 Yes  No

If no go to question 3.
If yes give details below:-

2.2 If you are renting property, is the property let furnished?

 Yes  No

2.3 Is the property held jointly?

 Yes  No

How many joint holders receive a share of the rent?

2.4 Please provide the amount of mortgage interest paid during the 2010/11 tax year.

2.5 The address of the property.

Rents receivable 06/04/10-05/04/11

Expenses
Please Include: Date | Description | Amount (£)

3. CAPITAL GAINS

3.1 Did you dispose of any capital items/assets during the tax year? i.e. Land & property (other than your main residence), shares, etc.

 Yes  No

If yes give details below:-

Please Include: Description Of Asset | Date Purchased (dd/mm/yyyy) | Purchase Price(£) | Date Sold (dd/mm/yyyy) | Disposal Value (£)

Please give details of any expenses (e.g. legal/agents, etc.) incurred in the purchase and/or disposal of the asset.
Please attach documentation (e.g. completion statements) relating to sale or purchase of items together with details of any enhancement expenditure.

4. EMPLOYMENTS, PENSIONS AND BENEFITS

4.1 Were you in paid employment at any time during the year ended 5 April 2011?

 Yes  No

If yes please provide: Name of Company | Date of commencement | Date of leaving, if appropriate | Total Pay | Tax Deducted | Tax Code for each employment

Did you have any benefits in this employment, please supply details of any benefits.

Please provide: Employment | Benefits Details | Benefit Amount

4.2 Did you receive any pensions or social security benefits (other than tax credits) during the year ended 5 April 2011?

 Yes  No

If yes give details below and enclose form P60 from the pension provider or documentation from the benefits office:-

Please Include: Description of Income | Name & Address of Pension Provider/ Benefits Office | Income Received (£) (Gross, Tax)

4.3 Have you any other income sources or involvements in any other businesses not referred to above?

 Yes  No

If so, please give brief details in the space below:-

5. PERSONAL ALLOWANCES

5.1 Married Couples Allowance.

Enter your date of birth (dd/mm/yyyy)

Enter your spouses date of birth (dd/mm/yyyy)

Full Name of Spouse

Date of Marriage (dd/mm/yyyy)

Maiden Name (if appropriate)

5.2 Are you liable to make Student Loan Repayments for 2010/11 on an Income Contingent Student Loan?

 Yes  No

Tick the ‘yes’ box if the Student Loan Company notified you that the repayment of your Income Contingent Student Loan commenced during the year to 5 April 2011 and you have not received confirmation from them that the loan has been repaid in full.

Amount of student loan outstanding

6. QUALIFYING LOANS

6.1 Have you any outstanding loans for funds raised to invest in a partnership or limited company (other than loans already included
in your business accounts)?

 Yes No

If yes give details below:-

Please Include: Purpose of Loan | Name of Lender | Interest Paid

Certificates from your lender are required in support of any claims for interest relief.

7. PERSONAL PENSION / RETIREMENT ANNUITIES

7.1 Did you make any payments to a personal pension, retirement annuity or AVC?

 Yes No

If yes give details below:-

Note: Enter the total payments you have made in the tax year on each policy

Please Include: Name of Pension Provider | Contract/Membership No & Type of Policy | Premiums Paid (Net) (06/04/10-05/04/11)

8. If you have made any Gift Aid Payments or other Annual Payments after basic rate tax (i.e. Subscriptions for Venture Capital Trust, Enterprise Investment Scheme etc) please provide details below:

If there is any other information you consider relevant to assisting us to complete your tax return please give details below:

9. If you are entitled to a repayment of tax do you want to nominate a charity to receive all or part of your repayment?

 Yes  No

If yes do you want the charity to receive all of your repayment?

 Yes  No

If no please state the amount you wish to nominate.

Do you wish Gift Aid to apply?

 Yes  No

Do you wish to remain anonymous?

 Yes  No

Please state your chosen charity.

YOUR TAX RETURN WILL NOT BE COMPLETE AND CORRECT UNTIL WE HAVE THIS INFORMATION.