Income Tax Form – UDEB Administratiekantoor

– Step 1 of 16

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

Country

Correspondence address

the same as registered address
other

Address

Address Line 1

Address Line 2

City

State / Province / Region

Country

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

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

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

Country

Correspondence address

same as mine
other

Adres / Address / Adres

Address Line 1

Address Line 2

City

State / Province / Region

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

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? *

III. 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 *

Click or drag a file to this area to upload.

File Upload "Jaaropgave" – Employment

Click or drag a file to this area to upload.

File Upload "Jaaropgave" – Employment

Click or drag a file to this area to upload.

File Upload "Jaaropgave" – Employment

Click or drag a file to this area to upload.

File Upload "Jaaropgave" – Benefit *

Click or drag a file to this area to upload.

File Upload "Jaaropgave" – Pension

Click or drag a file to this area to upload.

Own company

Name of company

KVK number

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

Car
Motor
Others

Car registration number *

Odometer on 1st of January *

Odometer on 31st of December *

Number of kilometers driven for business purposes *

Ex- partner

Name *

Surname *

Yearly amount of recived alimony in € *

Disposable benefit

Description

Yearly amount in €

Other

Alineatekstgebied

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 *

Click or drag a file to this area to upload.

File Upload "Jaaropgave" – Benefit *

Click or drag a file to this area to upload.

File Upload "Jaaropgave"- Pension

Click or drag a file to this area to upload.

Own company

Name of company

KVK number

Ex- partner

Name *

Surname *

Yearly amount of recived alimony in € *

Disposable benefit

Description

Yearly amount in €

Other

Partner – Andere

V. PROPERTY

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

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Country

WOZ-value

Purchase date //

upload notary bill

Click or drag a file to this area to upload.

upload notary bill

Sale date//

upload notary bill

Click or drag a file to this area to upload.

upload notary bill

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)

Do you pay ground rent for this property?

Fill in per year

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”

Click or drag a file to this area to upload.

Please upload “jaaroverzicht VVE”

Add another

Add another

Own property bought or sold in the year of declaration

Address

Address Line 1

Address Line 2

City

State / Province / Region

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 //

upload notary bill

Click or drag a file to this area to upload.

upload notary bill

Sale date//

upload notary bill

Click or drag a file to this area to upload.

upload notary bill

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)

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”

Click or drag a file to this area 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.

VI. MORTGAGE

Mortgage in year of declaration

Bank

Mortgage number

Date of mortgage//

Upload overview *

Click or drag a file to this area to upload.

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

Click or drag a file to this area to upload.

Date of the first mortgage in the Netherlands

Add another mortgage

Add another mortgage

Date of the first mortgage in the Netherlands

Bank

Mortgage number

Date of mortgage //

Upload mortgage overview

Click or drag a file to this area to upload.

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

Click or drag a file to this area to upload.

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 *

Click or drag a file to this area to upload.

Foreign bank accounts

Click or drag a file to this area to upload.

Dividends

Click or drag a file to this area to upload.

Stocks

Click or drag a file to this area to upload.

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

Upload Overview

Click or drag a file to this area to upload.

Cash on 01 january in the year of declaration

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

Upload Overview

Click or drag a file to this area to upload.

Capital insurance, savings account for repayment mortgage

Click or drag a file to this area to upload.

Building deposit

Click or drag a file to this area 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

Click or drag a file to this area to upload.

Other

Click or drag a file to this area to upload.

VIII. 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 overview dutch bank loan *

Click or drag a file to this area to upload.

Download overview foreign bank loan

Click or drag a file to this area to upload.

Download overview other loans

Click or drag a file to this area to upload.

Download overview study loan DUO

Click or drag a file to this area to upload.

Download overview debt with the bailiff

Click or drag a file to this area to upload.

Download overview credit card

Click or drag a file to this area to upload.

Private loan

Name, surname

Amount on 01 january in the year of declaration

Interest rate paid in in the year of declaration

Upload overview loan

Click or drag a file to this area to upload.

Other

Description

IX. DEDUCTIONS

Select what applies

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

Click or drag a file to this area to upload.

Travel statement from employer or public transport statement

Medical costs

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

Click or drag a file to this area to upload.

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

Click or drag a file to this area to upload.

Travel expenses for a hospital visit

Click or drag a file to this area to upload.

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

Koszty lekarstw na receptę / Prescription drugs’ costs / Medicijnen op doktersvoorschrift

Click or drag a file to this area to upload.

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

Click or drag a file to this area to upload.

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

Click or drag a file to this area to upload.

Home help costs for the sick person

Click or drag a file to this area to upload.

Donations

Description

Yearly amount in €

Add another

Add another

Description

Yearly amount in €

Ex- partner

Name, surname *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Country

Yearly amount of alimony paid in € *

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

Select what applies

Tax paid in advance
Tax refund received in advance

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

Click or drag a file to this area to upload.

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

Click or drag a file to this area to upload.

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

Click or drag a file to this area to upload.

XI. 30% RULING

30% ruling: start date

30% ruling: end date

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

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 *

Signature partner *