License
License
License
Help
If you need help with this form:
• follow the link above
• phone our helpline on 0300 200 3300
• if you are calling from outside the UK Phone +44 135 535 9022
Yr Iaith Gymraeg
Ffoniwch 0300 200 1900 i dderbyn fersiynau Cymraeg o ffurflenni a chanllawiau.
About you
Surname or family name
Mican
Line 1
17, Royal Mews, Dunmurry, Belfast,
Line 2
Northern Ireland
Line 3 (optional)
Postcode
BT179NJ
Telephone number
+34 643183195
Date of birth
30 12 1990
Nationality
Romanian
From the 6 April in the tax year you left the UK up to the date you left, were you resident in the UK?
For example: Your date of leaving the UK was 10 August 2013, use tax year 6 April 2013 to 5 April 2014
Yes
No
Were you a resident in the UK in the tax year before the tax year you left?
Yes
No
How many days do you expect to spend in the UK between your date of leaving the UK and the following 5 April?
15 Days
How many days do you expect to spend in the UK in each of the next three tax years? (From 6 April one year to 5 April the
next)
For example, 81 days between 6 April 2014 and 5 April 2015
Year 1
5 Days
Year 2
5 Days
Year 3
5 Days
Line 2
Lupeni
Line 3 (optional)
Hunedoara
Country
Romania
Will you continue to have your salary paid from the UK?
Yes
No
Account number
12273438
Line 1
Dunmurry, 183 Kingsway
Line 2
Dunmurry
Line 3 (optional)
Belfast
Postcode
BT179AH
Declaration
You must sign this declaration.
If you give information which you know is not correct or complete, action may be taken against you.
I declare that:
✔ - the information I have given on this form is correct and complete to the best of my knowledge.
- I claim repayment of any tax due back to me.
Signature
What to do now
Please send this form to:
Pay As You Earn
HM Revenue and Customs
BX9 1AS
We will let you know the outcome of this claim as soon as we can.