FCIM220070 - Where CDF offer is made 30 June 2014 onwards: appendices: appendix 7 - certificate of full disclosure

Sample form - do not use

To: HM Revenue & Customs

I …………………………………………………………

of……………………………………………………………

have read the statement overleaf and hereby certify that to the best of my knowledge and belief, I have made a complete disclosure to you of all:

1. accounts with banks, building societies or other financial institutions whether current or deposit, savings or loan, business or private:

a. which stand or at any time have stood in my own name or in the name of any business with which I have been concerned,

b. in which I am or have been interested or in which I have or have had power to operate or control, jointly or solely,

at any time during the period from…………………………………to………………………………………

2.assets and investments of whatever description and wherever kept (including Savings Certificates, Premium Bonds, life assurance policies, cash in hand, jewellery, furnishings and other valuables) which I or any business with which I have been concerned, have possessed or had any interest in at any time during the period from…………………………………to………………………………………

3. gifts, whether in cash or in any other form, made by me to any person (including my spouse or domestic partner, or my children) during the period from…………………………………to………………………………

4. sources of income not indicated in (1) and (2) above, and the amounts of income derived there from, and all facts relevant to my liability to pay any of the taxes, duties and national insurance contributions for which HM Revenue & Customs is responsible in the period from…………………………………to………………………………………..inclusive

5. facts relevant to the liabilities of any other business with which I have been concerned from…………………………………to…………………………………inclusive.

The amount of my own cash in hand at the present date does not exceed £……………………

The accounts referred to at (1) above are shown on the schedule of bank and building society accounts operated which was incorporated on the report prepared on my behalf by ……………………………………………… and dated ……………… .

Signed ………………………………………………

Date …………………………………

A witness is required to confirm that you have signed the certificate and that this is your signature.

Witness

(Signature) ………………………………………

(Name) ………………………………………………

(Address) ……………………………………………………………………………………………

(Date) ………………………………

Tax offences

Certificate of Full Disclosure

Where it has been established that you have understated your income, profits or gains or failed to notify your chargeability to tax, or that your VAT returns do not accurately reflect your VAT liability, HM Revenue & Customs will normally ask you to certify that you have made a complete disclosure of all the facts about your tax affairs for the period under review.

This will give you the chance to consider the statements you have made to HM Revenue & Customs. If at some later date it is found that the statements were materially incorrect HM Revenue & Customs will take a serious view of the false completion of the certificate and any loss of tax which may have arisen as a result.

Before you complete the certificate please consider the wording most carefully. If you consider there are any facts relating to your tax affairs or any assets held that you have not given details of, then inform the Officer of Revenue & Customs of these before you sign the certificate.

False statements can result in prosecution.

Issued by

HM Revenue & Customs