Capital Agency:: Application Form

0203 620 5900
0207 193 0245
0790 407 7992

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If you have any queries filling out this form please contact us ... we are here to help!

Please tick the tax year(s) you want to complete the tax return(s) for:

Year from 6 April 2013 to 5 April 2014

Year from 6 April 2012 to 5 April 2013

Year from 6 April 2011 to 5 April 2012

Other (please specify)

Section 1: Contact information

The security of your personal information is of paramount importance to us.
We are a registered agent with HM Revenue & Customs and we are bound by the Data Protection Act.

Full Name:

Telephone(s):

E-mail:

Section 2: Self employment

Were you self employed?

YES

2.1 Income Self employment

Net Income

Net Income figure is the money received to the bank account after tax has been deducted

What tax rate has been deducted?

20% standard rate

30% high rate

NO tax deductions

2.2 Expenses Self employment

2.2.1 Business related expenses

Labour costs

If you have employed any workers or engaged any sub-contractors you must be registered with HMRC as a contractor/employer. Please let us know if you require such registration. If you have been registered, please provide your Employer's Reference number below (PAYE reference number)

PAYE reference number

ONLY if you are registered as employer/contractor

Costs of goods used

Materials, tools: hire and purchase

Premises costs (business use ONLY)

Rent, rates, bills, repairs, telephone, internet etc

Travel expenses (business use ONLY)

The travel between work and home is ONLY allowed if you have been travelling to two or more sites/clients during the year and you either had no defined base of operations or your home was used as a base for business operations.

Other business related expenses

For example: accounancy fee, mobile, interest and bank charges, training, stationery, insurance and so on

2.2.2 AIA (Annual Investment Allowance)

Have you purchased any equipment (e.g. power tools etc), office furniture or computers during the year?

If yes, specify the amount (% business use ONLY)

2.2.3 Vehicle use

Have you used motor vehicle for the business during the year?

YES

What type of the vehicle is it? (e.g. car, van,motorbike)

Car/van running costs

Fuel, insurance, repairs, MOT, parking, tolls, Road Tax etc

What percentage of above vehicle costs are business use?

How many business miles have you travelled during the year?

Miles

Purchase price of the vehicle

Only cars or motorbikes

CO2 emission rate

Check your car's CO2 emissions on the Vehicle Certification Agency (VCA) website

Continue

Section 3: Employment PAYE

Have you been employed during the year?

YES

3.1 Employer(s) details

(can be found on P60/P45 forms or/and payslips)

Employer's name

Employer's PAYE reference number

More than one employer during the tax year?

Specify name and PAYE reference number for each employer

3.2 Income employment

List all your income for the year

From P60 and/or P45 forms

List all tax deducted

From P60 and/or P45 forms

Have you had any employment benefits?

If yes, specify the amount from P11D form

3.3 Expenses employment

Have you had any employment related expenses?

If yes, specify the amount (e.g. business trips (hotels, meals, business calls, professional fees and subscriptions etc)

Have you used private vehicle for business purposes?

If yes, list the business miles incurred and the mode of transport (e.g. car/van or motor cycle or cycle). Note, that travel between home and work is not allowable, ONLY business trips)

Have you received any payments from the employer to cover these expenses?

If yes, specify the amount

Continue

Section 4: Other income

Did you receive other income during this period?

YES

Did you receive any income from the following? (If yes, please list the amounts below)

Interest (e.g. bank, building society etc)?

Dividends (income from shares)?

UK Pensions (e.g. State Pension etc)

Incapacity or Job Seekers' Benefits

Any other income (please specify)

Did you pay into personal pension plan?

If yes, specify the amount

Were you entitled to receive Child Benefit?

YES

Continue

Section 5: Personal information and bank details

Date of Birth:

Full Address

Postcode:

Previous address(es) and Postcode(s)

Only required if you moved within the last 4 years

U.T.R. Number:

NI Number:

Marital status:

Any repayment from HMRC (Tax Office) will be transferred directly to the bank account of your choice. The account does not have to be in your name and can be sent to a nominees account.
Note that repayment will only be released after you have paid the fee to Capital Agency for the services provided.

Name of the bank

Name of the account holder

Sort code

Account number

Continue

Section 6: Declaration

Please sign to state that you have read and agree to our terms and conditions, and that you confirm that the information you have provided is accurate and correct to the best of your knowledge.

Sign or print your name

(if completed online)

Date

Agree with terms & conditions

Save my information

Call us:
0203 620 5900
0207 193 0245
0790 407 7992

Web: www.capitalagency.org.uk
Email: info@capitalagency.org.uk
Skype: capital.agency

Capital Agency Parthership
Office 3B,
Boardman House,
64 Broadway,
Stratford London E15 1NT