PPI Form test - Rebate Gateway

Claimant Details

Name*

First Last

Address*

Street Address Address Line 2 City Postcode

Telephone Number*

Email*

Have you previously been known by another name e.g Maiden Name?*

Yes

Previous Name*

First Last

Rebate Eligibility Confirmation

You could be eligible to claim a tax rebate!

Based on the information you have provided, you may be eligible to make a claim for a tax rebate, depending upon refunds paid out to yourself or a third party such as an insolvency practitioner.

Please click 'next' to proceed to complete the relevant claim form(s).

Employment status confirmation
HM Revenue & Customs calculates rebates on a sliding scale based on your income and employment circumstances. Please provide the following information as accurately as possible.
Since April 2017, have you been Employed, Self-Employed, Unemployed or Retired?*

Employed

Self-Employed

Unemployed

Retired

Current Employment
What is your job title?*

Name of Employer?*

Approximate start date*
DD slash MM slash YYYY

I still work here*

Yes

No
Approximate end date*
DD slash MM slash YYYY

PAYE Reference (optional)

NOTE: You can find the employer PAYE reference on your P60 or P45 (and sometimes on your payslip) and it will usually look something like 123/A56789. Providing your PAYE Reference will substantially speed up your repayment.
Estimated Salary*

NOTE: Providing an estimate of your annual salary (before tax) allows us to calculate the level of repayment you are entitled to.
Have you ever made a repayment claim for workplace expenses (such as for wearing uniform, purchasing tools or using your car for work?*

Yes

No
Would you like to process a repayment claim for workplace expenses?*

Yes

No

Employment History
Please add any further employments you have had since April 2018.
Previous Employment

Job Title Name of employer Start Date End Date Estimated Salary Actions

There are no Jobs.

Maximum number of jobs reached.

Working From Home Allowance
Due to COVID-19, HMRC allow you to claim a working from home allowance of £312, even if you worked at home for a single day in the year (online/telephone call/zoom meeting).
Have you worked from home (for any length of time) between 6th April 2020 and 5th April 2021 due to COVID-19?*

Yes

No
Have you worked from home (for any length of time) between 6th April 2021 and 5th April 2022 due to COVID-19*

Yes

No
Did your employer reimburse you for working from home costs?*

Yes

No
Have you already claimed the working from home allowance?*

Yes

No

Marriage Allowance
If you are married, you could be entitled to a rebate of up to £1188 depending upon your individual income circumstances.
Note: If our eligibility check identifies that you are eligible, we recommend it is claimed in conjunction with your current repayment claim - ensuring you are on the correct tax code for future tax years.
Are you married?*

Yes

No
Have you ever attempted to claim Marriage Allowance?*

Yes

No
What is the higher earners tax code?*

Over the last 4 years, who has been the higher earner?*

Me

My Partner
Since April 2018 has your annual income been between £12,500 and £50,000?*

Yes

No
Since April 2018 has your partners income been less than £12,500 at any point?*

Yes

No
Since April 2018 has your partners income been between £12,500 and £50,000?*

Yes

No
Since April 2018 has your annual income been less than £12,500 at any point?*

Yes

No
You are eligible for Marriage Allowance
You are eligible for Marriage Allowance – would you like to claim?*

Yes

No
You are eligible for Marriage Allowance
You are eligible for Marriage Allowance – would you like to claim?*

Yes

No
Date of marriage*
DD slash MM slash YYYY

Consent
I/We agree to have our data processed for the purpose of obtaining a rebate attributed to my/our tax affairs outlined in the application. Additionally, I/We can confirm that all of the information I/We have included in our application is true to the best of our knowledge and I/We understand that I/We have read, understood and agree to the Rebate Gateway Terms and Conditions
Partner 1
Enter National Insurance Number*

Date of Birth*
DD slash MM slash YYYY

Sign as acceptance of Terms of Engagement*
The digital signature provided above shall have the same validity as the original and will used to complete the documentation necessary in submitting your claim to HM Revenue & Customs. You will also be forwarded a pre-completed postal application to sign, date and return.
Partner 2
Partner Name*
First Last
Partner National Insurance Number*

Partner date of birth*
DD slash MM slash YYYY

Partners Signature*
The digital signature provided above shall have the same validity as the original and will used to complete the documentation necessary in submitting your claim to HM Revenue & Customs. You will also be forwarded a pre-completed postal application to sign, date and return.

Name of bank/lender	Approximate Refund	Year Refunded	Self Employed?	Actions

There are no Claims.

Claimant Details

Address Verification

About your PPI refund

Rebate Eligibility Confirmation

You could be eligible to claim a tax rebate!

Employment status confirmation

Current Employment

Employment History

Working From Home Allowance

Marriage Allowance

You are eligible for Marriage Allowance

You are eligible for Marriage Allowance

Consent

Partner 1

Partner 2

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