## Investment Club Certificate

Please read the notes on page 2 for information on when to complete this form.

Enter the member's proportionate share of income and gains (as either a fraction or percentage) from the club's investments Investment club's income for the year ended  0

| Club income                        | Member's share   |
|------------------------------------|------------------|
| Tax credits £                      |                  |
| Dividends received or              |                  |
| net income £                       | Tax credits £    |
| Dividends received or              |                  |
| net income £                       |                  |
| UK dividends                       |                  |
| Overseas dividends                 |                  |
| Savings income taxed at basic rate |                  |
| Untaxed income                     |                  |
Club details
Member's share
Net sale 
proceeds £
Capital 
gains £
Capital 
losses £
Net sale 
proceeds £
Capital 
gains £
Capital 
losses £
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Date of sale 
DD MM YYYY
Date of acquisition
DD MM YYYY
Name of company and description of holding
for example, ordinary or preference share
Schedule of gains and losses made during the year
Include realised gains and losses only
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Notes
Shortly after 5 April the Treasurer or other officer of the club should:
- prepare two copies of this form for each member of the club to indicate the member's share of the income, and capital gains or losses of the club for the year to 5 April
- give one copy to the member, and
- keep the second copy in the club's record.
The member should enter the details from this form onto their own tax return, if one is received. If a member does not normally receive a tax return and they have income or  
capital gains to declare, they can find guidance if they go to hmrc.gov.uk 
For more information about investment clubs go to hmrc.gov.uk