Income Tax Form – UDEB Administratiekantoor

– Step 1 of 20

Personal data

Name *

Surname *

Fiscal number (BSN) *

Date of birth *

Phone number

E-mail *

Confirm Email

Main residence *

Register residence adress
I do not have register residence adress

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Correspondence address

the same as registered address
other

Address

Address Line 1

Address Line 2

City

State / Province / Region

Country

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Income statement for the year *

Relationship status

Whole year married or with a fiscal partner
Whole year without a partner
Part of a year married or with a fiscal partner

Date of marriage or date of signing the partnership contract

Date of divorce

Registration

Registration whole year
No registration
Registration part of the year

Date of registration in NL

Date of deregistration in NL

Working period in The Netherlands – begining date

Working period in The Netherlands – last date

Country of residence before registration

Country of residence after deregistration

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Pre-completed tax return by the Tax Authorities *

Request activation code

Request activation code for continuous income tax authorization

This option concerns pre-filled tax return with activation code, I have authorized UDEB Administratiekantoor BV and I have agreed to the registration. For activation code check “Request activation code for continuous authorization income tax”.

Applicable situation

I. I have a fiscal partner
II. Child(ren)
III. Income: employment, benefits, pension etc., own company, recieved alimony, other income
IV. Partner income; income from The Netherlands and from abroad
V. Property
VI. Mortgage
VII. Properties, bank accounts, investment
VIII. Debts
IX. Deductions (medical costs, donations, travel costs etc.)
X. Tax paid in advance or, tax refund received in advance
XI. 30% ruling

Applicable situation (for pre-completed tax return)

I. I have a fiscal partner
VIII. Debts
IX. Deductions (medical costs, donations, travel costs etc.)
XI. 30% ruling

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I. FISCAL PARTNER

Name *

Surname *

Fiscal number (BSN)

Date of birth *

Phone number

E-mail *

Confirm Email

Main residence

same as mine
other

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Correspondence address

same as mine
other

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Registration

Registration whole year
No registration
Registration part of the year

Date of registration in NL

Date of deregistration in NL

Working period in The Netherlands – begining date

Working period in The Netherlands – last date

Country of residence before registration

Country of residence after deregistration

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Pre-completed tax return of your tax partner by the Tax Authorities *

Request an activation code for your tax partner

Request activation code for continuous income tax authorization

Check if applicable for tax partner (for pre-completed tax return)

I.I. Debts of tax partner
I.II. Deductions (medical expenses, public transport, donations, alimony paid)
XI. 30% ruling

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I.I. Debts of tax partner

Loans

Loan(s) as of January 1 of the year of filing

Check if applicable (debts of tax partner)

Loan from the bank in NL
Loan from a bank abroad
Other loans
Student debt DUO
Collection claims
Creditcard
Private loan
Other dept(s)

Upload overview of loan at the bank in the Netherlands (tax partner)

Drag & Drop Files, Choose Files to Upload

Upload overview of loan from the bank abroad (tax partner)

Drag & Drop Files, Choose Files to Upload

Upload overview of other loans (tax partner)

Drag & Drop Files, Choose Files to Upload

Upload overview of student debt DUO (tax partner)

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Upload overview of collection claims (tax partner)

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Upload credit card overview (tax partner)

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Private loan

First and last name

Debt as of January 1 of the year of declaration

Interest paid in the year of declaration

Upload overview of private loan (tax partner)

Drag & Drop Files, Choose Files to Upload

Other dept(s)

Amount of other debt

Description

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I.II. Deductions (medical expenses, public transport, donations, alimony paid)

Select what applies (tax partner deductions)

Costs of public transport from house to work
Medicl costs
Donations
Alimony paid) (not to children)

Public transport expences

This concerns costs that were NOT reimbursed by the employer.

Place of work (city) *

One way distance (10 km or more) *

How many days a week *

From… *

To… *

Add travel expenses statement

Drag & Drop Files, Choose Files to Upload

Medical costs

Always include printout of ”eigen risico” from the insurance comp *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Costs of the dentist, specialist, rehabilitation, hospital stay *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Travel expenses for a hospital visit *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

(only in the case of a visit from a person from the same household for more than 1 month at a distance of more than 10 km)

Prescription drugs’ costs (not refundable) *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Costs of aids (hearing aids, medical shoes, prostheses, dentures) *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Diet costs, e.g. gluten-free, lactose-free, oncology *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Home help costs for the sick person *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Donations

Description

Amount per year in €

Add another

Add another

Description

Amount per year in €

Ex-partner (alimetony paid)

First and last name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Country

Paid alimony per year in € *

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XI. 30% ruling

30% ruling: start date *

30% ruling: end date *

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II. CHILD(REN)

Details of your youngest child registered at the same address

Name *

Surname *

Date of birth *

Was your child registered at the same address for more than 6 months? *

The child was registered in the Netherlands at my address for more than 6 months
The child was registered at my partner’s address for more than 6 months
Co-ouderschap (if applicable)
The child was not registered in the Netherlands or wa registered for less than 6 months

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III. INCOME

Income from The Netherlands and from abroad

Employment
Benefit
Pension
Own company
Disposable benefit
Alimony received from (ex-) partner (not for children)
Other

File Upload "Jaaropgave" – Employment *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

File Upload "Jaaropgave" – Employment

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File Upload "Jaaropgave" – Employment

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File Upload "Jaaropgave" – Employment

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File Upload "Jaaropgave" – Benefit *

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File Upload "Jaaropgave" – Pension

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Own company

Name of company

KVK number

A private means of trasport used for business purposes, e.g. car, motorbike, bicycle *

Car
Motor
Others
Not applicable

Car registration number *

Odometer on 1st of January

Odometer on 31st of December

Number of kilometers driven for business purposes *

Alimony received from (ex-) partner

Name *

Surname *

Yearly amount of recived alimony in € *

Disposable benefit

Description disposable benefit

Yearly amount in € *

Other

Alineatekstgebied

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IV. PARTNER INCOME

Income from The Netherlands and from abroad

Employment
Benefit
Pension
Own company
Alimony received from (ex-) partner (not for children)
Disposable benefit
Other

File Upload "Jaaropgave" – Employment *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

File Upload "Jaaropgave" – Benefit *

Drag & Drop Files, Choose Files to Upload

File Upload "Jaaropgave"- Pension

Drag & Drop Files, Choose Files to Upload

Own company

Name of company

KVK number

Alimony recived from ex-partner

Name *

Surname *

Yearly amount of recived alimony in € *

Disposable benefit

Description

Yearly amount in €

Other

Partner – Andere

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V. PROPERTY

Property

Own house (apartment) in the Netherlands or outside the Netherlands

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

WOZ-value

Purchase date

Attach the notary's invoice only if the property was purchased this year

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Attach the notary’s invoice only if the property was purchased this year

Sale date

Attach the notary's invoice only if the property was sold this year

Drag & Drop Files, Choose Files to Upload

Attach the notary’s invoice only if the property was purchased this year

Applicable situation *

This property is my registered residence address
This house is vacant or a holiday home
Building plot or house under construction
This house is occupied by someone else
This property is a plot (other than a building plot)
Other

Do you pay ground rent for this property?

Yearly amount

In case of ownership of an apartment, funds accumulated by the housing company VVE on 01 january in the year of declaration

Please upload “jaaroverzicht VVE”

Drag & Drop Files, Choose Files to Upload

Please upload “jaaroverzicht VVE”

I have another property

Add property

Next property

Own property bought or sold in the year of declaration

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

WOZ-value

Ownership in %

Geselecteerde waarde: 50

I’m the owner of

Ownership partner %

Geselecteerde waarde: 50

My partner owns

Ownership others %

Geselecteerde waarde: 0

Ownership others

Purchase date

Attach the notary's invoice only if the property was purchased this year

Drag & Drop Files, Choose Files to Upload

Attach the notary’s invoice only if the property was purchased this year

Sale date

Attach the notary's invoice only if the property was sold this year

Drag & Drop Files, Choose Files to Upload

Attach the notary’s invoice only if the property was sold this year

Applicable situation *

This property is my registered residence address
This house is vacant or a holiday home
Building plot or house under construction
This house is occupied by someone else
This property is a plot (other than a building plot)
Other

In case of ownership of an apartment, funds accumulated by the housing company VVE on 01 january in the year of declaration

Please upload “jaaroverzicht VVE”

Drag & Drop Files, Choose Files to Upload

Please upload “jaaroverzicht VVE”

Do you have more properties?

If you own more properties we ask you to send us all the information you’ve filled in above for your other propertie(s) seperately bij e-mail.

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VI. MORTGAGE

Mortgage

Mortgage in year of declaration

Bank

Mortgage number

Date of mortgage

Upload annual statement *

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If mortgage was signed in the year of declaration – Costs of mortgage: financial advisor, notary

Drag & Drop Files, Choose Files to Upload

Add another mortgage

Add another mortgage

Bank

Mortgage number

Date of mortgage

Upload annual statement

Drag & Drop Files, Choose Files to Upload

If mortgage was signed in the year of declaration – Costs of mortgage: financial advisor, notary

Drag & Drop Files, Choose Files to Upload

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VII. PROPERTIES, BANK ACCOUNTS, INVESTMENTS

It also applies to children up to 18 years of age, children’s property is subject to your settlement

Applicable situation

Dutch bank accounts – also children up to 18 years of age
Foreign bank accounts – also children up to 18 years of age
Dividends
Stocks
Cryptocurrency in € owned on 01 january in the year of declaration
Cash on 01january in the year of declaration
Participation in Ltd company
Capital insurance, savings account for repayment mortgage
Building deposit
Loan granted to third parties
Other

Dutch bank accounts *

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Foreign bank accounts

Drag & Drop Files, Choose Files to Upload

Dividends

Drag & Drop Files, Choose Files to Upload

Stocks

Drag & Drop Files, Choose Files to Upload

Cryptocurrency in € owned on 01 january in the year of declaration

Upload Overview

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Cash on 01 january in the year of declaration

LTD

Participation in Ltd company

Shares names

Number of shares

Ownership in %

Geselecteerde waarde: 50

Value of shares on 01 january in the year of declaration

Capital insurance, savings account for repayment mortgage

Drag & Drop Files, Choose Files to Upload

Building deposit

Drag & Drop Files, Choose Files to Upload

Loan granted to third parties

Name, surname of debtor *

Amount of loan on 01 january in the year of declaration *

Interest rate paid in the year of declaration

Please attach the loan settlement as of January 1 of the accounting year

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Other

Drag & Drop Files, Choose Files to Upload

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VIII. DEBTS

Debts

Overview of loan(s) as of 01 january in the year of declaration

Applicable situation

Dutch bank loan
Foreign bank loan
Other loans
Study loan DUO
Debt with the bailiff
Credit card
Private loan
Other

Download annual statement dutch bank loan *

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Download annual statement foreign bank loan

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Download annual statement other loans

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Download annual statement study loan DUO

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Download annual statement credit card

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Loan

Private loan

Name, surname

Amount on 01 january in the year of declaration

Interest rate paid in in the year of declaration

Upload loan agreement

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Other

Description

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IX. DEDUCTIONS

Select if applicable

Costs of public transport from house to work
Medical costs
Donations
Alimony paid to ex-partner (not to children)

Costs of public transport from house to work

Fill in only in case when employer DOES NOT cover transport costs

Place of work (place) *

One-way distance in km (only if more than 10 km) *

Days per week *

From… *

To… *

Attach confirmation

Drag & Drop Files, Choose Files to Upload

Travel statement from employer or public transport statement

Medical costs

Always include printout of ”eigen risico” from the insurance company *

Drag & Drop Files, Choose Files to Upload

Costs of the dentist, specialist, revalidation, hospital stay *

Drag & Drop Files, Choose Files to Upload

Travel expenses for a hospital visit

Drag & Drop Files, Choose Files to Upload

(in the case of hospitalized person from the same household longer than 1 month at a distance of more than 10 km)

Prescription drugs’ costs (not refundable)

Drag & Drop Files, Choose Files to Upload

Medical aid costs (hearing aids, medical shoes, prostheses)

Drag & Drop Files, Choose Files to Upload

Diet costs, e.g. gluten-free, lactose-free, oncological

Drag & Drop Files, Choose Files to Upload

Home help costs for the sick person

Drag & Drop Files, Choose Files to Upload

Donations

Description

Yearly amount in €

Add another donation

Add another donation

Description

Yearly amount in €

Alimony paid to ex-partner

Name, surname *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Country

Yearly amount of alimony paid in € *

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X. TAX PAID IN ADVANCE OR TAX REFUND RECEIVED IN ADVANCE

Select *

Tax paid in advance
Tax refund received in advance
Not applicable

Provide the total amount in € of the advance received *

Amount of income tax paid attach copy of voorlopige aanslag for the year of declaration) *

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Amount paid for social security (copy of voorlopige aanslag ZVW for the year of declaration)

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Amount of income tax received copy of voorlopige teruggave for the year of declaration) *

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XI. 30% RULING

30% ruling: start date *

30% ruling: end date *

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XII. Please enter the date when you wish the statement to be sent to the Belastingdienst

Please enter the date when you wish the statement to be sent to the Belastingdienst *

As soon as possible
Enter date

Date *

Other

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Declaration *

I declare that the questionnaire has been filled in truthfully. At the same time, I consent to the electronic sending of tax returns and the receipt of copies of tax returns by UDEB Administratiekantoor BV. This survey is an order to perform settlement works according to the valid price list. I declare that I have read the valid price list. I hereby declare that all pre-contractual information obligations referred to in Art. 6: 2301 of the Dutch Civil Code, have been complied with. I have been informed (and clearly understood) about the main characteristics of the service, the identity of the seller, the total price or service, how the price is calculated and, where applicable, what additional costs are due. I have been informed about the method of payment, the duration of the contract and the method of its termination. Finally, I certify that I have sufficiently understood this agreement and have received incomprehensible terms and texts translated by an independent party. I declare that I entrust the Processor with personal data for processing, on the terms and for the purpose specified in the Agreement on the Protection of Personal Data. The processor undertakes to process the personal data entrusted to him in accordance with this agreement, the Regulation and other provisions of generally applicable law that protect the rights of data subjects. The processor declares that it applies security measures that meet the requirements of the Regulation. I declare that I had the opportunity to get acquainted and I acquainted with the above-mentioned agreement posted on the website www.udeb.nl https://udeb.nl/privacy-en-cookieverklaring/ https://udeb.nl/verwerkersovereenkomst/ https://udeb.nl/algemene-voorwaarden/

Date

Signature *

Clear Signature

Signature partner *

Clear Signature

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