Tax Rebate

Please fill in the form below. All fields marked with * are mandatory. At least one of home, work or mobile is mandatory.

Shipping Invoice Number (if applicable)

Title (Mr/Mrs/Ms/Dr etc) *

Surname *

Forename(s) *

Country of Nationality

Country of residence prior to arrival in UK

Grounds for claiming nationality

Date of Birth (dd/mm/yy)

Home Address in the UK *

Previous Address in UK

Home Tel Number

Work Tel Number

Fax Number

Email *

Mobile

National Insurance Number

Occupation

Marital Status

Date of Marriage (if applicable) dd/mm/yy

Date of Birth of Spouse (if applicable) dd/mm/yy

Overseas Address including Postcode (if leaving the UK)

Overseas Home Tel Number

Overseas Work Tel Number

Overseas Fax Number

Overseas Email

Overseas Mobile

When does your entrance visa expire?

Given correct details Rebates can be:

Account Name:

Sort Code/BSB No (Aus)/Routing Code (US) (max 6 digits)

Bank & Branch

Bank Account Number:

IBAN Number (EU):

Arrival Date (dd/mm/yy)

Departure date (dd/mm/yy) (if leaving the UK)

If Leaving/Left UK do you intend to return in next 12 months

If YES when do you plan to recommence employment in the UK (dd/mm/yy)

Details of Employment

Which is the most recent tax year you have previously claimed for

Employer 1

Name and Address

Starting Date:	Finish Date:

P60	P45
Statement of earnings

Employer 2

Name and Address

Starting Date:	Finish Date:

P60	P45
Statement of earnings

Employer 3

Name and Address

Starting Date:	Finish Date:

P60	P45
Statement of earnings

Employer 4

Name and Address

Starting Date:	Finish Date:

P60	P45
Statement of earnings

Employer 5

Name and Address

Starting Date:	Finish Date:

P60	P45
Statement of earnings

Please advise dates of unemployment (if longer than 2 months) - from (dd/mm/yy)

Please advise dates of unemployment (if longer than 2 months) - to (dd/mm/yy)

Any additional source of income while living in UK

If Yes please give details

Is there any additional information that may be relevant to your claim

If Yes please give details:

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Anglo Pacific Tax Services, Castlewood House, 77-91 New Oxford Street, London WC1A 1DG

Tel: 0800 039 3088, Fax: 0845 880 1256, Email: rebates@anglopacifictax.co.uk