Certificate of deduction of income tax
For HMRC use
‘Duty assessed’ stamp Office stamp
This form should be completed by the person
making a payment of interest, an alternative
finance receipt, annual payment or annuity where
income tax has been deducted from the payment.
The person receiving the payments should keep this form. It will be needed if a claim for repayment of tax is made.
I certify that on paying to
of
the amount shown in box 2 below I deducted the income tax shown in box 3, and that this tax has been or
will be paid by me either directly or by deduction from other income when received by me.
1 Nature of payment, for example, interest, alternative 9 Other details
finance receipt, annuity, or annual payment • if you are employed, your employer’s name
and address
• if you are a company or if you are in business,
the business address
Name
|
2 Gross payment £ |
| Address
|
3 Income tax deducted
£ |
|
by me Postcode
|
4 Net payment £ |
|
10 Office to which your returns or your employer’s
returns are made
5 Date payment was made / /
Reference (if known)
6 Period for which payment was due
Signature
from / / to / /
7 Date on which payment due / / Date
/ /
8 Enter in CAPITAL letters your name and address
Name
The person deducting the tax and responsible for
accounting for it to HM Revenue & Customs should
Address sign this form. You should say if you are deducting tax
on behalf of your employer, for example as secretary
or cashier.
Postcode
R185 HMRC 03/06