## Individual'S Repayment Claim

Your reference If these details are incorrect, please amend them here. 

Please use this reference if you write or phone. 

It will help to avoid delay.

Issued by Phone

## Claim For Repayment Of Subcontractor Deductions In The Tax Year To 5 April 2015

Use this form to claim repayment of deductions made during the tax year to 5 April 2015.

When not to use this form Use your tax return instead of this form if you are making your claim **after** 5 April 2015, the end of the tax year. 

If you are in a partnership, rather than in business on your own, ask us for claim form CIS41(2014) 'Partner's repayment claim'. 

To make your claim:
-  complete each part of this form in turn, unless you are 
directed otherwise 
-  keep a record of the details from the payment and
deduction statements for the tax year, ready to complete
your tax return after 5 April 2015 
-  send the **original** payment and deduction statements 
to us at the above address, together with this fully
completed form 
We will work out any repayment you are due. 

## How To Decide When To Claim Repayment Complete This Part First To Help Decide If You Should Claim Repayment Now.

My tax affairs are up to date. (This includes sending in tax returns and Employer and Contractor payments.) 
Put X in one box.

My business accounts which end in the year to 5 April 2015
have been prepared and the business profits are now known or the business has ceased and final accounts have been prepared. Put X in one box.

Yes No Yes No I hold the **original** payment and deduction statements for the tax year, fully completed by the contractor, showing the deductions made. Put X in one box.

If you have put an X in all the Yes boxes in this part, go to
'Personal details' on page 2. If you are unable to answer yes to one or more of the statements you should not make a claim now. 

Yes No Please contact any HM Revenue & Customs office if you need help.

I have paid all tax and Class 4 National Insurance contributions due. Put X in one box.

Yes No

## Personal Details Complete For All Claims.

3
1
Your National Insurance number
Your date of birth  DD MM YYYY
2
4
Are you married or in a civil partnership? 
Put X in one box.
Your daytime phone number (It is often easier to clear up any queries on your claim 
over the phone.)

| Yes   | No   | If No, go to question 3   |
|-------|------|---------------------------|

If Yes, enter your husband's or wife's or civil partner's date of birth  DD MM YYYY

## Details Of The Claim We May Ask For Evidence To Support The Details You Enter Here.

5
8
Has the business ceased? Put X in one box.
Enter the total deductions from the payment and
deduction statements for the period since 6 April 2014

| Yes   |
|-------|
| £     |
| -     |

6
9
Enter the date, between 6 April 2014 and now, on 
which **either** your business ceased or your business
accounting period ended  DD MM YYYY
Enter the total of any other income you have received 
since 6 April 2014 which has not had Income Tax
deducted, treated as deducted or treated as paid

£
•

7
For the accounting period ending on the date you 
have shown above in question 6, please enter:
the gross business income, excluding VAT

1
£
•

We will normally send any repayment by cheque to you at the address shown on page 1. If you want to receive repayment in this way, please continue by completing the 'Declaration' on page 3. 

the total allowable business expenses and capital allowances

2
£
•

If you want the repayment sent to a bank or building society account, or to **someone else** (a nominee), complete 
'Sending the repayment elsewhere' on page 3 followed by the 'Declaration'. 

the net business profit (box 1 minus box 2)

3
£
•

## Sending The Repayment Elsewhere A Nomination Here Relates To This Claim Only.

Would you prefer a repayment to go to your bank or building society or to a nominee?  
Fill in either (a) or (b) below, then complete the 'Declaration'. 

(b) Send the repayment by cheque to my nominee, 
shown below.
(a) Send the repayment direct to the bank or 
building society account, as detailed below. 

## Declaration Complete For All Claims. False Statements Can Result In Prosecution.

I:
- enclose all the **original** payment and deduction statements
- have kept copies of the payment and deduction statements 
- authorise any repayment to be made to the person shown at (a) or (b) above, if applicable
- confirm that the information I have given here is correct and complete to the best of my knowledge and belief 
Signature Date  DD MM YYYY