TFT TAX PAYMENT FORM British Tax Reference Number (if relevant) TFT/030/1/UK Period under review:- TOTAL TAX PAYABLE • I declare on behalf of * that the amount stated at A & B are correct. • I further declare that there is a further documentary evidence to substantiate these amounts and that this evidence will be made available to the Revenue Commission for inspection when requested to do in Revenue Commission. • I declare that the payment has accounted for TFT for which it was required to amount in respect of all transfer transactions. For Official use only PAYMENT ONLY • I enclose the amount outlined in (A) and (B) above and have completed the pay slip at the end of the form. Signed:- declarant Title:- (Mr / Mrs. Etc) Date / / TFT PAYSLIP Name For: COLLECTION GENERAL TELEGRAPHIC FUND TRANSFER SECTION OFFICE OF THE REVENUE COMMISSIONER NEW WING, SOMMERSET HOUSE, STRAND, LONDON WC2R 1LB CORPORATION Tax REGISTRATION No (where relevant) Payment Date:. I DECLARE THAT THE AMOUNT BELOW IS THE AMOUNT I AM LIABLE TO REMIT TO THE COLLECTOR GENERAL € / $ / £ SIGNED DATE THIS IS NOT A BANK GIRO TFT