Form R43 - Claim To Personal Allowances And Tax Repayment By An Individual Not Resident In The Uk Page 3

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If you have previously made a claim for exemption from UK tax under a double taxation treaty for any of the pensions/
benefits you have shown in C4 or C5 give:
• your reference number with us
/
/
• the date you made your claim
C6
Income from trusts or settlements or from the estates of deceased persons
If your tax certificate or statement of income shows that the tax is non-repayable, write 'non-repayable' in box C6.2
Name of trust, settlement or estate
Unique Taxpayer Reference (UTR) of the trust
Please read the note about R185(Trust Income) in
Net amount of income -
Tax paid or tax credit
after tax taken off
the ‘Guidance notes for form R43(2016)’
C6.1
C6.2
£
£
C7
Other UK income
Give details of income, including any untaxed income, from:
• flexible pension payments
• employment in the UK, a trade, profession or vocation performed in the UK
• property income distributions paid by UK real estate investment trusts or property authorised investment funds
• any other UK income not shown elsewhere in this form
(
Enter type of income below)
Gross amount before tax
Tax taken off
C7.1
C7.2
£
£
C8
Chargeable event gains on UK life insurance policies, life annuities or capital redemption policies
Amount of gain(s)
Tax treated as paid
Give details of any gains on UK life insurance policies,
C8.1
C8.2
£
£
life annuities or capital redemption policies
D
Deductions paid out of income liable to UK tax, including donations to UK charities
Type of payment
Amount paid
D1
£
E
Income from UK government FOTRA securities from which UK tax has been taken off
as appropriate
E1
Since 5 April 2009, have you spent:
Yes
No
• 183 days or more in the UK in any one
tax year?
• 91 days a tax year on average in the UK?
If you answer 'Yes' to either question, give details on a separate sheet.
Title(s) of FOTRA security or securities and dates acquired
Income before tax
Tax taken off
E2
E3
£
£
All claimants must answer question F1
F
Claim for UK tax allowances
To make a claim follow these instructions:
• to claim the Personal Allowance, complete part F1
• for other allowances, tick the box(es) in parts F2 and F3
• if you are not entitled to allowances, tick the box at F4
F1
Personal Allowance
Tick the box that applies to you and enter details where requested.
I have read note 3 of the booklet ‘Guidance notes for form R43(2016)’ and claim the Personal Allowance because I am:
a British citizen or a national of another member state of the European Economic Area (EEA)
resident in the Isle of Man or the Channel Islands
entitled to claim under any of the conditions shown in c, d, e, f or g in
note 3 of the ‘Guidance notes for form R43(2016)’
(enter the condition)
a national and also a resident of (enter name of country)
a national of Israel or Jamaica (please state which)
a resident of (enter name of country)
Tick here if you were born before 6 April 1938. Read note F1 in the ‘Guidance notes for form R43(2016)’
about the higher personal allowance.
3

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