PPI Form test - Rebate Gateway

"*" indicates required fields

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

Employment Status
HM Revenue & Customs calculates some rebates on the type of taxpayer you are - (ie, basic rate, higher rate). You may also be due allowances based on your 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
Have you had to complete a Self-Assessment tax return in any of the last 4 years?*

Yes

No

Current Employment
What is your job title?*

Name of Employer?*

NOTE: Please ensure you enter the name of your Employer as it appears on your payslip. Your claim may be rejected if this is not correct.
Approximate start date*
DD slash MM slash YYYY

I still work here*

Yes

No
Approximate end date*
DD slash MM slash YYYY

PAYE Reference

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.
Do you wear a uniform/protective clothing for this Employment?*

Yes

No
Are you responsible for the washing/maintaining of your Uniform/Protective Clothing*

Yes

No
Would you us to process a rebate request for Flat Rate Expenses (FRE) associated with your Uniform/Protective Clothing?*

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, even a day) between 6th April 2020 and 5th April 2021 due to COVID-19?*

Yes

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

Yes

No
Have you already been compensated by your Employer for your Working From Home (WFH) expenses?*

Yes

No
Have you already made a Working From Home (WFH) expenses claim?*

Yes

No
Would you like to receive a rebate payment for your Working From Home (WFH) allowance?*

Yes

No

Marriage Allowance
If you are married, you could be entitled to a rebate of up to £1250 depending upon income circumstances over the last 4 years.
Note: If our eligibility check identifies that you are eligible and you wish to claim, we would require your partners Personal Details, as well as their authorisation to make a claim.
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
Please select which years your Partners income has been below £12,500*

2018/2019

2019/2020

2020/2021

2021/2022

ALL YEARS
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 & Agreement
Hidden
No Rebate, No Fee!
You are not required to make any upfront payment to make a claim. Our fee is settled directly out of the refund from HMRC, upon funds from your rebate being forwarded to Rebate Gateway via Nomination. By providing consent in signing below, you agree to this nomination. For more information on 'Nomination', please see our FAQ.

Our fee for successful claims is 39% + VAT or a minimum of £35 plus VAT. For more information, please see our full Terms and Conditions.
Partner 1
Enter National Insurance Number*

Date of Birth*
DD slash MM slash YYYY

Signature*
Consent & Acceptance of Terms*
I Agree
I confirm that I have read, understood and agree to the Rebate Gateway Terms and Conditions. Additionally, I accept and agree that the digital signature provided above shall have the same validity as the original and will used to complete documentation necessary in submitting your claim to HM Revenue & Customs. I agree to have our data processed for the purpose of obtaining a rebate attributed to my tax affairs outlined in the application. I can confirm that all of the information I have included in my application is true to the best of my knowledge.
Partner 2
Partner Name*
First Last
Partner National Insurance Number*

Partner date of birth*
DD slash MM slash YYYY

Partners Signature*
Partner Consent & Acceptance of Terms*
I Agree
I confirm that I have read, understood and agree to the Rebate Gateway Terms and Conditions. Additionally, I accept and agree that the digital signature provided above shall have the same validity as the original and will used to complete documentation necessary in submitting your claim to HM Revenue & Customs. I agree to have our data processed for the purpose of obtaining a rebate attributed to my tax affairs outlined in the application. I can confirm that all of the information I have included in my application is true to the best of my knowledge.

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

There are no Claims.

Claimant Details

Address Verification

About your PPI refund

PPI Tax Rebate Completion Confirmation

You could be eligible to claim a tax rebate!

Employment Status

Current Employment

Employment History

Working From Home Allowance

Marriage Allowance

You are eligible for Marriage Allowance

You are eligible for Marriage Allowance

Consent & Agreement

No Rebate, No Fee!

Partner 1

Partner 2

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