Important information to include on your tax return before sending it to us.

Please make sure you

include your:
• 10 digit Unique Taxpayer
Reference (UTR) Please make sure you
• National Insurance include your full name and
number (NINO) address before sending us
Tax return – Page TR 1
• employer reference (if you your tax return.
have one) UTR
NINO Issue address
before sending us your Employer reference

tax return. Date UTR

NINO Issue address
HM Revenue & Customs office address
Employer reference

Date
UTR
HM Revenue & Customs office address
NINO Issue address
Employer reference

Date
For
HM Revenue & Customs office address
Telephone Reference

Your tax return

This notice requires you, by law, to make a return of your How to file your return For
taxable income and capital gains, and any documents Telephone
Most people file online. To do this go to hmrc.gov.uk/online Reference
requested, for the year from 6 April 2013 to 5 April 2014. To file on paper, please fill in this form using the rules below.

If you don’t, we may have to Deadlines

UTRYour tax return Cross out any mistakes
NINO Use black ink and capital letters and write the correct
This notice requires you, by law, to make ainformation
return of below
your How to file youraddress
Issue return
send your tax return back to We must receive your tax return by these dates:
Employer reference
taxable income
Name of bank or building society
and capital gains, and any documents
4
State Pension lump sum 8 Most people file online. To do this go to hmrc.gov.uk/online
• if you are using a paper return – by 31 October 2014 !"#$%!"&
requested, for the year from 6 April 2013 to £
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Date
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(or 3 months after the date of this notice if that’s later). Use black ink and capital letters and write the correct
for example, £4,700.21
HM
If your return is late you will be charged a £100 penalty. Revenue
We mustwould & beCustoms
receive £4701
your tax office
return by address
these office to send your tax
Pensions (other than State Pension), retireme

dates:
10

4 Name of bank or building society

information below
8 State Pension lump sum

For
If your return is more than 3 months late, you will be • if you are using a paper return – by 31 October 2014
• Enter your figures to the nearest pound – ignore the pence. return to, look on the most
!"#$%!"& £ !""#""$""%""& ¢ 0 0

Signing your form and sending it back

Telephone charged daily penalties of £10 a day.
Reference
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up expenses later),
tax or paid 9 Tax taken off box 8
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If you pay late you will be charged interest and a late

Please fill in this section and sign and date the declaration at box 22.
• if
(or
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• 3If
are
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– it is to your benefit.
months after
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for example, £4,700.21
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payment penalty. 10 Pensions (other than State Pension), retireme

Your tax return

20 If this tax return contains provisional or estimated 23 If you have signed on behalf of someone else, enter
If yourthrough
return empty
is late boxes
you orbe
will write anything
charged a else. penalty.
£100
If your return is more than 3 months late, you will be
from us. If you don’t have
would be £4701

• Enter your figures to the nearest pound – ignore the pence.

figures, put
This‘X’ notice
in the box
requires you, by law, to make the capacity.
a return
Starting of your
your tax return How to file your return
For example, executor, receiver charged daily penalties of £10 a day. any
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and round up expenses and tax paid
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and capital documents
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21 If you are enclosing separate supplementary pages,
Page
put ‘X’ TR
in the8 boxof your completed
Deadlines
Your personal details
Use black inkStarting your tax return
Cross out any mistakes
24 Enter the name of the person you have signed for capital
and letters and write the correct Pay AsFor You Earn and
tax return before sending it
We must receive your tax return by these Your date of birth – it helps get your tax right
dates: 1 Telephone
Before you Your phone number information
start to fill it in, look through 3 return to make sure there Reference
your taxbelow is a section for all your income and claims
DD MM YYYY – you may need some separate supplementary pages (see page TRSelf
4 Name of bank or building society Assessment
2 and the Tax Return Guide). To get notes and helpsheets
State Pension lump sum
to us. • if you are using a paper return – by 31 October 2014
8

22 Declaration Your
!"#$%!"&
tax return
that will help you fill in this form, go hmrc.gov.uk/selfassessmentforms
£ to !""#""$""%""& 0 0
HM Revenue & Customs
¢

(or 3 months after the date of this notice if that’s later), or

I declare that the information I have given on this tax Your personal details
#"")

• if you are filing a return online – by

25 If you filled in boxes 23 and 24 enter your
31 January 2015
Thisname
notice requiresYour National
you, by Insurance
law, to number
make – leave
4 blank if of
a return the your
BX9 1AS
9
How to file your return
Tax taken off box 8

return and any supplementary pages is correct and Your name and address – if it is different
2
Please round
from what is onup tax paid, correct number is shown£above #""'""&""( 0 0 ¢

the front of this form. Please write the correct details

taxable income and capital gains, and any documents
1 Your date of birth – it helps get your tax right 3 Most number
Your phone people file online. To do this go to hmr
complete to the(or 3ofmonths
best afterand
my knowledge thebelief.
date of this notice if that’s later). for example, £4,700.21
requested, for the year from 6 April
underneath the wrong ones, and put ‘X’ in the box DD MM YYYY 2013
Pensions (other than to
State5 April
Pension),
10 2014.
retireme To file on paper, please fill in this form using
I understand that I may have to pay financial penalties would be £4701
If your return is late you will be charged a £100 penalty.
and face prosecution if I give false information. Cross ou
If your return is more than 3 months late, you will be • Enter your Deadlines
figures to the nearest pound – ignore the pence. 4 Use black
Your National ink and
Insurance capital
number letters
– leave blank if the and writ
Signing
26 and your
yourform and sending it back
address
Signature charged daily penalties of £10 a day.Please informat
section and sign and date theRound
declarationdown income 1andand
round
tax up
We 2 Your name
must address – if itexpenses
is different and
from tax
what paid
is on correct number is shown above
SA100 2014
fill in this atPage
box 22. TRreceive your return by these HMRCdates:
12/13 4 Name of bank or building society
8 State Pension l
the front of this form. Please write the correct details
If you pay late you will be charged interest and a late • if you
– it is to your are usingthe
benefit.
underneath
a paperones,return put – by in 31theOctober 2014 !"#$%!"& £ !""#
20 If this tax return contains provisional or estimated 23 If you have signedwrong
on behalf of and
someone ‘X’ box
else, enter
payment penalty. figures, put ‘X’ in the box • If a box does (ornot
3 the
months
capacity.after
apply, please
For the leave
example,date ofitreceiver
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not strike 9 Tax taken off b

• if youboxes
through empty are filing a return
or write online –else.
anything by 31 January 2015 Please round up tax paid, £ #

Date DD MM YYYY Postcode (or 3 months after the date of this notice if that’s later). for example, £4,700.21 10 Pensions (othe

If you are enclosing separate supplementary pages, SA100 2014 Page TR 1 would be £4701 HMRC 12/13
21
If your return is late you will be charged a £100 penalty.
put ‘X’ in the box
Starting your tax return 24 Enter the name of the person you have signed for
If your return is more than 3 months late, you will be • Enter your figures to the nearest pound – i
charged daily penalties of £10 a day. Round down income and round up expens
Before you start to fill it in, look through your tax return to make sure there is a section for all your income and claims
22 Declaration If you pay late you will be charged interest and a late – it is to your benefit.
– you may need some separate supplementary pages (see page TR 2 and the Tax Return Guide). To get notes and helpsheets
I declare that the information I have given on this tax
payment penalty.
25 If you filled in boxes 23 and 24 enter your name • If a box does not apply, please leave it blan
that will help you fill in this form, go to hmrc.gov.uk/selfassessmentforms
return and any supplementary pages is correct and
through empty boxes or write anything els
complete to the best of my knowledge and belief.

Your personal details I understand that I may have to pay financial penalties
and face prosecution if I give false information.

Signature Starting your

and your
26 address tax return

1 Your date of birth – it helps get your tax right 3 Your phone
Before younumber
start to fill it in, look through your tax return to make sure there is a section for all your income an
DD MM YYYY – you may need some separate supplementary pages (see page TR 2 and the Tax Return Guide). To get notes a
that will help you fill in this form, go to hmrc.gov.uk/selfassessmentforms
Date DD MM YYYY Postcode

Your personal details

4 Your National Insurance number – leave blank if the
2 Your name and address – if it is different from what is on correct number is shown above
Tax return – Page TR 8 1 Your date of birth – it helps get your tax right 3 Your phone number
the front of this form. Please write the correct details DD MM YYYY
underneath the wrong ones, and put ‘X’ in the box

Please do not include this information sheet with your

Your name tax– ifreturn.
and address it is different from what is on 2
4 Your National Insurance number – leav
correct number is shown above
the front of this form. Please write the correct details
SA100 2014 Page TR 1 underneath the wrong ones, and HMRC 12/13
put ‘X’ in the box

SA100 2014 Tax return: Information sheet HMRC 12/13

 Tax Return 2014
Tax year 6 April 2013 to 5 April 2014

UTR
NINO Issue address
Employer reference

Date

HM Revenue & Customs office address

Finishing your tax return

Calculating your tax – if we receive your tax return by 31 October 2011, or if you file online, we will do the calculation for
you and tell you how much you have to pay (or what your repayment will be) before 31 January 2012.
But if you want to calculate your tax ask us for the Tax calculation summary pages and notes. The notes will help you work
out any tax due or repayable, and if payments on account are necessary.
Income
Tax refunded or set off
Interest and dividends from UK banks, building socie
1 If you have had any 2010–11 Income Tax refunded or set off by us or Jobcentre Plus, enter the amount
1 Taxed UK interest etc. – the net amount after tax has been 4 O
For £ 0 ¢ 0 taken off (see notes)
£
Telephone Reference £ ¢ 0 0
If you have not paid enough tax 5 Fo
Untaxed
Use the payslip at the foot of your next statement (or reminder)2from us to UK
payinterest
any taxetc.
due.– amounts which have not been af

Your tax return

taxed (see notes) am
2 If you owe tax for 2010–11 and have a PAYE tax code, we If you are likely to owe tax for 2011–12
¢ 0 0on income other
£3 £
will try to collect the tax due (if less than £2,000) through than employed earnings or pensions, and you do not want us

This notice requires you, by law, to make a return of your How to file your return
your tax code for 2012–13, unless you put ‘X’ in the box
– read page TRG 22 of the guide 3
to use your 2011–12 PAYE tax code to collect that tax during
Dividends fromput
the year, UK ‘X’
companies
in the box– –do notpage
read include
TRGthe
22 of the guide 6 Ta
tax credit (see notes)
taxable income and capital gains, and any documents Most people file online. To do this go £to hmrc.gov.uk/online £
0 0 ¢

requested, for the year from 6 April 2013 to 5 April 2014. To file onhave
If you paper, please
paid too fill in this form using the rules below.
much tax
We will repay direct to your bank or building society accountUK
– thispensions, annuities
is the safest and and other
quickest method. stateyou
Tell us where benefits
would likerece
any repayment to be made by filling in boxes 4 to 14. Cross out any mistakes
Deadlines Use black
If you ink
would like and
us to
your tax return pack.
capital
send some, letters
or all, of
7 State Pension – the amount due for the year (see notes)
and write the ¢ correct
your repayment to charity please use the Giving your tax repayment to charity form in
£ 0 0
11 Ta

£
information below
We must receive your tax return by these dates: 4 Name of bank or building society
8
10 If you have entered a nominee's name in box 5, put ‘X'
State Pension lump sum 12 Ta

• if you are using a paper return – by 31 October 2014

in the box
ANY BANK Em
£ ¢ 0 0
£
(or 3 months after the date of this notice if that’s later), or 9 Tax taken off box 8

• if you are filing a return online – by 31 January 2015

11 If your nominee is your tax adviser, put ‘X' in the box
13 Ta
Please round
5 Name of accountup tax
holder paid,
(or nominee) £ ¢ 0 0
£
(or 3 months after the date of this notice if that’s later). for example, £4,700.21 10 Pensions (other than State Pension), retirement annuities
would be £4701 12 Nominee's address
and taxable triviality payments – give details of the payers, 14 Jo
If your return is late you will be charged a £100 penalty. amounts paid and tax deducted in box 19 on page TR 6
£
If your return is more than 3 months late, you will be • Enter Branch
your
6
figures to the nearest pound
sort code £
– ignore the pence. 0 0 ¢

— — To 15
charged daily penalties of £10 a day. Round down income and round up expenses and tax paid £
If you pay late you will be charged interest and a late – it is Account
to your
7 number
benefit. and postcode 13
Other UK income not included on supplementary pa
payment penalty. • If a box does not apply, please leave it blank – do not strike
Do not use this section for income that should be returned on supple
through 8
empty boxes or write anything
Building society reference number
else.
life insurance gains and certain other kinds of income go on the Addi
To authorise your nominee to receive any repayment,
14
16 you must
Other taxable sign in– the
income box.expenses
before A photocopy of your signature
and tax 19 Be
will not do
taken off
9 If you do not have a bank or building society account, £
£ 0 0
Starting your tax return
¢
or if you want a cheque to be sent to you or to your
nominee, put ‘X' in the box 20 De
17 Total amount of allowable expenses – read page TRG 14 of en

Before you start to fill it in, look through your tax return to make sure there is a section for all your income the guide
and claims inf

£ 0 0 ¢
– you may need some separate supplementary pages (see page TR 2 and the Tax Return Guide). To getPage
Tax return: notes
TR 5 and helpsheets HMRC 12/10

that will help you fill in this form, go to hmrc.gov.uk/selfassessmentforms Any tax taken off box 16 18

£ ¢ 0 0

Your personal details Tax return: Page TR 3

1 Your date of birth – it helps get your tax right 3 Your phone number
DD MM YYYY

4 Your National Insurance number – leave blank if the

2 Your name and address – if it is different from what is on correct number is shown above
the front of this form. Please write the correct details
underneath the wrong ones, and put ‘X’ in the box

SA100 2014 Page TR 1 HMRC 12/13

What makes up your tax return
To make a complete return of your taxable income and gains for the year to 5 April 2014 you may need to complete some
separate supplementary pages. Answer the following questions by putting ‘X’ in the ‘Yes’ or ‘No’ box.

1 Employment 6 Trusts etc.

If you were an employee, director, office holder or agency
worker in the year to 5 April 2014, do you need to complete
Employment pages? Please read the guide before answering.
Fill in a separate Employment page for each employment,
directorship, etc. On each Employment page you complete,
enter any other payments, expenses or benefits related to
that employment. Say how many Employment pages you
are completing in the Number box below.
Yes No Number
2 Self-employment
Did you work for yourself (on your ‘own account’ or
in self-employment) in the year to 5 April 2014?
(Answer ‘Yes’ if you were a ‘Name’ at Lloyd’s.)
Fill in a separate Self-employment page for each
business. On each Self-employment page you complete,
enter any payments or expenses related to that business.
Say how many businesses you had in the Number
box below.
Yes No Number
3 Partnership
Were you in partnership? Fill in a separate Partnership
page for each partnership you were a partner in and say
how many partnerships you had in the Number box below.
Did you receive, or are you treated as having received,
income from a trust, settlement or the residue of
a deceased person’s estate? This does not include cash
lump sums/transfer of assets, otherwise known as capital
distributions, received under a will.
Yes No
7 Capital gains summary
If you sold or disposed of any assets (including, for
example, stocks, shares, land and property, a business),
or had any chargeable gains, read the guide to decide
if you have to fill in the Capital gains summary page.
If you do, you must also provide separate computations.
Do you need to fill in the Capital gains summary page
and provide computations?
Yes No Computation(s) provided
8 Residence, remittance basis etc.
Were you, for all or part of the year to 5 April 2014,
one or more of the following – not resident or not
domiciled in the UK and claiming the remittance basis,
applying split year treatment, or dual resident in the UK
and another country?
Yes No

Yes No Number 9 Supplementary pages

4 UK property
Did you receive any income from UK property (including
rents and other UK income from land you own or
lease out)? Read the guide if you have furnished
holiday lettings.
If you answered ‘Yes’ to any of questions 1 to 8, please
check to see if within this return, there is a page dealing
with that kind of income etc. If there is not, you will need
separate supplementary pages. Do you need to get and
fill in separate supplementary pages?
Yes No

Yes No If ‘Yes’, you can go to hmrc.gov.uk/selfassessmentforms

to download them, or phone 0300 200 3610 and ask us
for the relevant pages.
5 Foreign Some less common kinds of income and tax reliefs
If you:
(not covered by questions 1 to 8), and details of
• were entitled to any foreign income, or income gains
disclosed tax avoidance schemes, should be returned
• have, or could have, received (directly or indirectly)
on the Additional information pages enclosed in the
income, or a capital payment or benefit from a
tax return pack. Do you need to fill in the Additional
person abroad as a result of any transfer of assets
information pages?
• want to claim relief for foreign tax paid
read the guide to decide if you have to fill in the
Yes No
Foreign pages. Do you need to fill in the Foreign pages?

Yes No

SA100 2014 Page TR 2

Income
Interest and dividends from UK banks, building societies etc.
1 Taxed UK interest etc. – the net amount after tax has 4 Other dividends – do not include the tax credit.
been taken off. Read the guide Read the guide

£ • 0 0 £ • 0 0

2 Untaxed UK interest etc. – amounts which have not had
tax taken off. Read the guide
£ • 0 0
3 Dividends from UK companies – do not include the
tax credit. Read the guide
5 Foreign dividends (up to £300) – the amount in sterling
after foreign tax was taken off. Do not include this
amount in the Foreign pages
£ • 0 0
6 Tax taken off foreign dividends – the sterling equivalent

£ • 0 0 £ • 0 0

UK pensions, annuities and other state benefits received

7 State Pension – the gross amount shown on your 11 Tax taken off box 10
pension statement. Read the guide
£ • 0 0
£ • 0 0
12 Taxable Incapacity Benefit and contribution-based
8 State Pension lump sum Employment and Support Allowance – Read the guide

£ • 0 0 £ • 0 0

9 Tax taken off box 8 13 Tax taken off Incapacity Benefit in box 12

£ • 0 0 £ • 0 0

10 Pensions (other than State Pension), retirement 14 Jobseeker’s Allowance

annuities and taxable triviality payments – give details
of the payers, amounts paid and tax deducted in the
£ • 0 0
‘Any other information’ box, box 19, on page TR 7
– enter tax taken off in box 11 15 Total of any other taxable State Pensions and benefits

£ • 0 0 £ • 0 0

Other UK income not included on supplementary pages

Do not use this section for income that should be returned on supplementary pages. Share schemes, gilts, stock dividends,
life insurance gains and certain other kinds of income go on the Additional information pages in the tax return pack.

16 Other taxable income – before expenses and tax 19 Benefit from pre-owned assets – Read the guide
taken off
£ • 0 0
£ • 0 0
20 Description of income in boxes 16 and 19 – if there
17 Total amount of allowable expenses – Read the guide is not enough space here please give details in the
‘Any other information’ box, box 19, on page TR 7
£ • 0 0

18 Any tax taken off box 16

£ • 0 0

SA100 2014 Page TR 3

Tax reliefs
Paying into registered pension schemes and overseas pension schemes
Do not include payments you make to your employer’s pension scheme which are deducted from your pay before
tax or payments made by your employer. If you paid in excess of £50,000, you should consider completing the
‘Pension savings tax charges’ section on page Ai 4 of the Additional information pages.

1 Payments to registered pension schemes where basic
rate tax relief will be claimed by your pension provider
(called ‘relief at source’). Enter the payments and basic
rate tax
3 Payments to your employer’s scheme which were not
deducted from your pay before tax
£ • 0 0

£ • 0 0 4 Payments to an overseas pension scheme, which is not

2 Payments to a retirement annuity contract where basic
rate tax relief will not be claimed by your provider
£ • 0 0
UK-registered, which are eligible for tax relief and were
not deducted from your pay before tax
£ • 0 0

Charitable giving
5 Gift Aid payments made in the year to 5 April 2014 9 Value of qualifying shares or securities gifted to charity

£ • 0 0 £ • 0 0

6 Total of any ‘one-off’ payments in box 5 10 Value of qualifying land and buildings gifted to charity

£ • 0 0 £ • 0 0

7 Gift Aid payments made in the year to 5 April 2014 11 Value of qualifying investments gifted to non-UK
but treated as if made in the year to 5 April 2013 charities in boxes 9 and 10

£ • 0 0 £ • 0 0

8 Gift Aid payments made after 5 April 2014 but to be 12 Gift Aid payments to non-UK charities in box 5
treated as if made in the year to 5 April 2014
£ • 0 0
£ • 0 0

Blind Person’s Allowance

13 If you are registered blind on a local authority or other 15 If you want your spouse’s, or civil partner’s, surplus
register, put ‘X’ in the box allowance, put ‘X’ in the box

14 Enter the name of the local authority or other register 16 If you want your spouse, or civil partner, to have your
surplus allowance, put ‘X’ in the box

Other less common reliefs are on the Additional information pages enclosed in the tax return pack.

SA100 2014 Page TR 4

Student Loan repayments
Please read the guide before filling in boxes 1 to 3.

1 If you have received notification from the Student 3 If you think your loan may be fully repaid within
Loans Company that repayment of an Income the next two years, put ‘X’ in the box
Contingent Student Loan began before 6 April 2014,
put ‘X’ in the box

2 If your employer has deducted Student Loan

repayments enter the amount deducted

£ • 0 0

High Income Child Benefit Charge

Only fill in this section if:
• your income was over £50,000, and
• you or your partner (if you have one) were entitled to receive Child Benefit (this also applies if someone else claims
Child Benefit for a child who lives with you and pays you or your partner for the child’s upkeep), and
• couples only – your income was higher than your partner’s.
Please read the guide.
If you have to pay this charge for the 2014–15 tax year and you do not want us to use your 2014–15 PAYE tax code
to collect that tax during the year, put ‘X’ in box 3 on page TR 6.

1 Enter the total amount of Child Benefit you and your 2 Enter the number of children you and your partner
partner were entitled to receive for the year to were entitled to receive Child Benefit for on
5 April 2014 5 April 2014

£ • 0 0

Service companies
1 If you provided your services through a service company (a company which provides your personal services to third
parties), enter the total of the dividends (including the tax credit) and salary (before tax was taken off) you withdrew
from the company in the tax year – Read the guide

£ • 0 0

Finishing your tax return

Calculating your tax – if we receive your tax return by post or online by 31 October 2014, we will do the calculation
for you and tell you how much you have to pay (or what your repayment will be) before 31 January 2015.
We will add the amount due to your Self Assessment Statement, together with any other amounts due.
Do not enter payments on account, or other payments you have made towards the amounts due, on your tax return.
We will deduct these on your Self Assessment Statement.
If you want to calculate your tax, ask us for the Tax calculation summary pages and notes. The notes will help you
work out any tax due or repayable, and if payments on account are necessary.

Tax refunded or set off

1 If you have had any 2013–14 Income Tax refunded or set off by us or Jobcentre Plus, enter the amount

£ • 0 0

SA100 2014 Page TR 5

If you have not paid enough tax
Use the payslip at the foot of your next statement (or reminder) from us to pay any tax due.

2 If you owe tax for 2013–14 and have a PAYE tax code,
we will try to collect the tax due (if less than £3,000)
through your tax code for 2015–16, unless you put ‘X’
in the box – Read the guide
3 If for 2014–15, you are likely to owe tax on the
High Income Child Benefit Charge or on income
other than employed earnings or pensions, and you
do not want us to use your 2014–15 PAYE tax code
to collect that tax during the year, put ‘X’ in the box
– Read the guide

If you have paid too much tax

If you fill in your bank or building society account details we can make any repayment due straight into your account.
This is the safest and quickest method. But, if you do not have a suitable account, put ‘X’ in box 9 and we will send you
or your nominee a cheque.

4 Name of bank or building society 11 If your nominee is your tax adviser, put ‘X’ in the box

12 Nominee’s address

5 Name of account holder (or nominee)

6 Branch sort code

13 and postcode
— —

7 Account number
14 To authorise your nominee to receive any repayment,
you must sign in the box. A photocopy of your
signature will not do
8 Building society reference number

9 If you do not have a bank or building society account,

or if you want us to send a cheque to you or to your
nominee, put ‘X’ in the box

10 If you have entered a nominee’s name in box 5,

put ‘X’ in the box

SA100 2014 Page TR 6

Your tax adviser, if you have one
This section is optional. Please read the guide about authorising your tax adviser.

15 Your tax adviser’s name 17 The first line of their address including the postcode

16 Their phone number Postcode

18 The reference your adviser uses for you

Any other information

19 Please give any other information in this space

SA100 2014 Page TR 7

Signing your form and sending it back
Please fill in this section and sign and date the declaration at box 22.

20 If this tax return contains provisional or estimated 23 If you have signed on behalf of someone else, enter
figures, put ‘X’ in the box the capacity. For example, executor, receiver

21 If you are enclosing separate supplementary pages,

put ‘X’ in the box
24 Enter the name of the person you have signed for

22 Declaration
I declare that the information I have given on this tax 25 If you filled in boxes 23 and 24 enter your name
return and any supplementary pages is correct and
complete to the best of my knowledge and belief.
I understand that I may have to pay financial penalties
and face prosecution if I give false information.
26 and your address
Signature

Date DD MM YYYY Postcode

SA100 2014 Page TR 8