P11D/S336 Claim Tax Year Ended 5 April: (Enter Year)

P11D/S336 Claim – Tax year ended 5 April: …………………… (enter year)

PLEASE COMPLETE THE FOLLOWING

Company Name: ……………………………………………………………………………………………...

Employee: ………………………………… M/F …..….. Please write “Yes” if director…………..

National Insurance Number: …………………………… Date of Birth: ……………………………

I) QUALIFICATIONS (I.E. CONDITIONS WHERE BENEFITS IN KIND MAY ARISE)

PLEASE TICK AGAINST EACH OF THE FOLLOWING IF APPLICABLE (EXCLUDING THOSE ITEMS FOR WHICH ANY HMRC DISPENSATION HAS BEEN RECEIVED) AND THEN COMPLETE THE RELEVANT SECTIONS IN PART II (FACTS AND FIGURES)

(i) POTENTIAL BENEFITS IN KIND ON WHICH YOU, THE EMPLOYEE, CAN BE TAXED

and on which Class 1A National Insurance will be payable by the employer, your company

A. Company owned assets taken over by you from the company for private usage (e.g. computer, laptop, car or other)

D. Living accommodation provided by the company to you or anyone nominated by you (e.g. family/friends) (partly or wholly used by you but not necessarily in the performance of your business duties)

F. Company cars (provided by the company for business and/or private use) and fuel (provided for business and/or private use)

G. Company vans (provided by the company for business and/or private use) and fuel (provided for business and/or private use)

I. Private medical treatment or medical/health insurance paid by the company for you or your family

J. Company payments in respect of your qualifying relocation expenses (where the total in the tax year exceeds £8,000)

K. Company payments made to provide you with non-company business services if you were not personally invoiced for them

L. Company owned assets made available for your private, non-company business use (but not for your ownership) (e.g. computer, laptop or other (excluding motor vehicles)

M. Company payments for personal (not corporate) membership fees to professional bodies or personal (not corporate) subscription payments to professional bodies or associations or any other services such as staff entertainment which has been arranged by and charged to the company and not to you, the employee

(ii) POTENTIAL BENEFITS IN KIND ON WHICH YOU THE EMPLOYEE CAN BE TAXED

but on which no Class 1A National Insurance may be payable by the employer, your company

MX. Company payments for personal (not corporate) membership fees to professional bodies or personal (not corporate) subscription payments to professional bodies or associations or other services such as staff entertainment which has been arranged by and charged to you, the employee and not the company

N. Company payments made to you or to third parties on your behalf, for company business expenses such as travelling & subsistence, use of private telephone, use of home as office (which would include heating, lighting, rates, rent, council tax, mortgage interest), client entertainment, (which have an element of personal benefit as well)

(iii) YOU OWE THE COMPANY

B. Company payments made to third parties on your behalf (where third parties have invoiced you directly for non-company business purposes)

C. Company Credit Cards (non-company business / employee’s private use)

E. Company payments made for non-company motor vehicles including any motoring costs for example, petrol, repairs, servicing, insurance, road fund tax etc. but excluding company business use parking charges, tolls, congestion charge or any mileage allowance for company business miles actually incurred.

Note: Company Payments may be made by the company or by you on behalf of the company in the following manner:

Petty cash, company debit card, company credit card, company cheques, postal orders, bank payment orders, bank transfers, Paypal etc.

I confirm that I have read and understood the foregoing

…………………………………………………………………… ………………………………………………………

Signed Date

II) FACTS AND FIGURES

A. Company owned assets taken over by you from the company for private usage (e.g. computer, laptop, car or other)

Description / Date / Gross amount paid by the company
£ / Market value according to you on asset takeover
£ / Contribution made by you
£

B. Company payments made to third parties on your behalf (where third parties have invoiced you directly for non-company business purposes)

Description / Date / Gross amount paid by the company
£ / Contribution made by you
£

C. Company Credit Cards (non-company business / employee’s private use)

Description / Date / Gross amount paid by the company
£ / Contribution made by you
£

D. Living accommodation provided by the company to you or anyone nominated by you (e.g. family/friends) (partly or wholly used by you but not necessarily in the performance of your business duties)

Address & postcode / Date available from / Date available to / Total rent & services paid by the company for the accommodation for the period
£ / Contribution made by you
£

E. Company payments made for non-company motor vehicles.

Description / Gross amount paid
£
COMPANY PAYMENTS MADE OR CREDITED TO THE LOAN ACCOUNT
Petrol
Repairs & Accessories
Servicing
Car wash
Insurance
Road fund tax
Breakdown cover
SUB TOTAL = X
BUSINESS USAGE ITEMS INCURRED BY YOU PERSONALLY AND NEITHER RECLAIMED NOR CREDITED TO THE LOAN ACCOUNT
Parking charges (to be included in travelling & subsistence)
Tolls (to be included in travelling & subsistence)
Congestion Charge (to be included in travelling & subsistence)
Mileage (please also advise number of miles)
SUB TOTAL = Y
BUSINESS USAGE ITEMS PAID BY COMPANY OR CREDITED TO THE LOAN ACCOUNT (NOT REQUIRED IF A DISPENSATION FOR TRAVELLING & SUBSISTENCE IS IN PLACE
Parking charges (to be included in travelling & subsistence)
Tolls (to be included in travelling & subsistence)
Congestion Charge (to be included in travelling & subsistence)
Mileage (please also advise number of miles)
SUB TOTAL = Z
IF X IS MORE THAN Y – DEBIT DIRECTOR’S LOAN A/C AS AT 5 APRIL WITH THE DIFFERENCE AND INCLUDE THIS FIGURE IN SECTION H AS AN AMOUNT OWED BY YOU TO THE COMPANY (POSITIVE FIGURE)
IF X IS LESS THAN Y – CREDIT DIRECTOR’S LOAN A/C AS AT 5 APRIL WITH THE DIFFERENCE AND INCLUDE THIS FIGURE IN SECTION H AS AN AMOUNT OWED TO YOU BY THE COMPANY (NEGATIVE FIGURE)

F. Company Cars – all questions under this heading must be answered

Make and Model ……………………..………………………………………...… Registration number ……………………………

Date first registered ..……………………………………………………………………………..……………

Approved CO2 emissions figure for vehicles registered on or after 1 January 1998 …..…………………….. g/km

If you do not know the CO2 emissions, you can find it out as follows:

· For vehicles registered between 1 January 1998 and 28 February 2001, from the manufacturer

· For vehicles first registered in the UK from 1 March 2001, the vehicle registration document/certificate

Engine size ………………….. cc

Type of fuel. Please note that all Diesel vehicles

registered after 1 January 2006 are Euro IV Diesel ……………………………………………….……………………….……….

Please choose from: Bi-Fuel or gas only, conversion, diesel, electric, hybrid, euro IV diesel, petrol or petrol and up to 85% bioethanol.

Date car available from: ………………………….…...…… Date car available to ……………..…………………..…………….

List price when new (including standard accessories) …………………………………………………………..…………………

Price of optional accessories (min £100) ……………………………………………..………………………….…………...…….

Capital contributions (maximum £5k) made by

You towards the cost of the car or accessories ………………………………………………………………………..…….

Amount paid by you for private use of the car ..……………………………………………………………………………..…….

Private fuel provided by the company YES / NO. If yes, do you fully reimburse the company with the fuel cost YES / NO

G. Company vans and van fuel

Make and Model ……………………..………………………………………...… Registration number ……………………………

Date van available from: ………………………….…...…… Date van available to ……………..…………………..…………….

If there was shared usage during the available period, please state your percentage of usage ………………………………..

Amount paid by you for private use of the van ..……………………………………………………………………………..……….

Private fuel provided by the company YES / NO. If yes, do you fully reimburse the company with the fuel cost YES / NO.

H. Company loans (staff or Director’s Loan Account, which should also include the items described below under section (iii) “You owe the company”, on which full interest at official rate has not been paid by you to the company). Please also include the opening balance whether positive (owed by you to company) or negative (owed by company to you).

Date loan taken / Amount of loan:
Owed by you / (Owing to you) as per your up to date spreadsheet
£ / Amount of loan repaid
£ / Date loan repaid / Balance of loan
£ / Interest paid by you to the company or agreed by you to be debited to your loan account
£
Brought forward loan amount at 06/04
Total loan outstanding at 05/04

I. Private medical treatment or medical/health insurance paid by the company for you or your family

Description / Date / Gross amount paid by the company
£ / Contribution made by you
£

J. Company payments in respect of your qualifying relocation expenses (where the total in the tax year exceeds £8,000)

Description / Date / Gross amount paid by the company
£ / Contribution made by you
£

K. Company payments made to provide you with non-company business services if you were not personally invoiced for them

Description / Date / Gross amount paid by the company
£ / Contribution made by you
£

L. Company owned assets made available for your private, non-business use (but not for your ownership) (e.g. computer, laptop or other (excluding motor vehicles)

Description / Date asset
Made available / Date asset available to / Market value according to you when first made available
£ / Percentage of private usage / Contributions made by you for private usage
£

Description / Date / Gross amount paid by the company
£ / Wholly exclusively & necessarily incurred in the performance of my duties as an employee of the company
(Section 336 claim)
YES / NO

Declaration

I confirm that the information given in response to this questionnaire is true, accurate and consistent with the underlying accounting books and records used for production of the company’s accounts and for reporting to HMRC.

Signed ………………………………………………………….. Date ………………………………………….……..

Name: ……………………………………………………………

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