INDIVIDUAL TAX RETURN FORM
SERVICE LEVEL	Please select Basic Service Standard Service Comprehensive Service Premium Service	ADDRESS LINE 1
		ADDRESS LINE 2
TITLE	Please select Mr Mrs Miss Ms Dr Other	ADDRESS LINE 3
FORENAME		TOWN
SURNAME		POSTCODE
DATE OF BIRTH
		TELEPHONE
MARITAL STATUS	Please select Single Married Divorced Widowed Co-habiting	MOBILE PHONE
NATIONAL INSURANCE NUMBER		FAX
EXISTING ACCOUNTANT?	Please select Yes No	EMAIL ADDRESS
If yes you must give the name address and phone number of your accountant in the box below. This is required to comply with professional rules.
Summarise all your sources of income and available allowances, amounts are not important at this stage – we  will send a more detailed questionnaire:
Money laundering regulations It is a statutory requirement that we establish your identity is bona fide. We can be subject to criminal proceedings if we do not satisfy ourselves on this point. Before commencing to act for you we will require proof of your identity. We will ask you for what we require with the letter of engagement .
I would request you to consider accepting my instructions in accordance with your standard Letter of Engagement subject to appropriate modification. I confirm that no contract shall exist between us until you haveaccepted instructions and issued a letter of engagement to me.
Peter Brown & Co is a trading name of Undershot Ltd, registered in England , no 4114468. Director :- P.Brown FCCA, FCIE,DchA,BSc.The registered office is Acomb Grange, Grange Lane, York, YO23 3QZ. Last modified 07/02/09