Apss146e 1217

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Application for a certificate of residence

or certification of a tax reclaim form


About this form
Use this form to apply for a certificate of residence in respect of a registered pension scheme. You should only apply for a
certificate of residence if you have had tax deducted from the income of a non UK investment and you wish to reclaim the
tax back from an overseas tax authority. You can also use this form to request certification of tax reclaim forms from overseas
tax authorities.

Contact details
1 Name Agent Authority
If you act as a third party on behalf of the fund, please
make sure the relevant authority has been filed with
HM Revenue and Customs (HMRC). If not, please attach it to
2 Phone number this request to avoid any delays. If you have already sent an
authorisation for this pension scheme you do not need to
send another. (3)

3 Email address

Pension scheme details


4 Pension scheme name 6 Pension scheme tax reference

7 Unique Taxpayer Reference (UTR)

5 Address (address to appear on certificate of residence) 8 Return address (if different from fund address)

Postcode Postcode

APSS146E Page 1 HMRC 12/17


Countries Period for certification (1) Source of income Relevant Article Certificate of Certification of tax
DD MM YYYY (e.g. Dividends, Number from Double residence - reclaim form -
Interest, Royalties) Taxation Agreement tick if required (2) tick if required

Declaration
Please tick the box that applies. Full name

I confirm that the pension scheme is set up under trust,


and either
• all the trustees were resident in the UK for the period Signature
of certification, or
• there was a mix of UK resident and non UK trustees and
either the member or the employer were UK resident
when they paid contributions into the pension scheme
during the period of certification Date DD MM YYYY

I confirm that the pension scheme is not set up under


trust and that the scheme is administered and managed
in the UK.

Other information
Please give us details of any specific wording (already agreed with HMRC)
Notes
1. Generally, a certificate of residence is valid for 12 months from the date of issue. HMRC cannot certify residence for
a future period.
2. Certificates are usually provided in paper format and we will normally only send one copy of each certificate. HMRC allow
the fund to produce as many copies as it needs from our original copy.
3. Provide a completed APSS146C and APSS146D as appropriate.

What to do next
When you have filled in this form please send it to:
Pension Schemes Services
HM Revenue and Customs
BX9 1GH
United Kingdom
For more advice:
• go to www.gov.uk/topic/business-tax/pension-scheme-administration
• phone the helpline on 0300 123 1079

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