THE CHECKLIST INCOME TAX V2
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1 This part is reserved for &VAN DER KLOET Type of form Year of return Checked on Client nr PERSONAL INFORMATION Declarant Name & Date of Birth Address, Zip Code & City Telephone Number & E- mail Fiscal Number (BSN) & Nationality Bank account (for tax returns) Profession It is possible that a position has to be taken in your income tax return. What approach would you like to take? Progressive Neutral Defensive Optimal tax savings No opinion Avoid any conflicts Partner Do you have a partner? Yes, Married No Living together Registered partnership Divorced? Per NO / YES Per: Did your partner receive an income tax return form? Does &Van der Kloet file the income tax return for your partner? If so, please fill in a separate checklist for your partner. If not, please provide us with a copy of his or her tax return. Did you or your partner receive an estimated tax assessment for the year 2010? please enclose copies Please specify your partners income His or her Name & Date of Birth His or her Fiscal Number (BSN) & Nationality Children under the age of 30 Do you have children under the age of 30? Did you receive childsupport or a student grant for any of your children in 2010? Did any of your children go to daycare and/or kindergarten? if no, please specify their cost of living. please send yearend statement from either and possible assessments Kinderopvangtoeslag Did you go on parental leave in 2010? please enclose parental leave declaration made by your employer Children in your care, under 30 # Initials Date of Birth Fiscal Number (BSN) info@vanderkloet.nl Page 1
2 4 FROM EMPLOYMENT, WELFARE, PENSION, ETC. Did you receive income from employment,welfare, a please enclose the annual statement pension or alike in 2010? Place Start date End date Days Per Week Paid employment : Did you travel to work by means of public transport in 2010? Distance one way in km s: Days per week: please enclose declarations Did you pay or receive alimony to/from your ex-partner? please specify amounts Did you receive any other, non-typical income from your employment in 2010? Did you receive income from freelance activities or similar in 2010? Did you have a Verklaring ArbeidsRelatie (VAR) or declaration 30% ruling in 2010? please specify amounts please specify (income + expenses!) please enclose a copy Did you run your own business in 2010? SELF EMPLOYMENT / BUSINESS PROFITS Did you work more than 1225 hours in your business in 2010? When did you start your business? Did you use space that qualifies as independent in your own home for business purposes in 2010? Did you drive a company car? Brand Type Licence Plate regular or delivery car? Year Of Construction Value In Catalogue Own Contribution NO / YES During which period in 2010 was the car at your disposal? From: To: Did you drive more than 500 km in private in 2010? ( please enclose a complete kilometre administration Did you receive any allowance for commuter transport?... Did your partner work for your business in 2010? Partner If so, how many hours did he or she work for your business? If so, did your partner receive payments for his or her work?... If so, did your partner or your family place any property at your business disposal in 2010? If so, were any payment made? please specify... info@vanderkloet.nl Page 2
3 Did you own the house you were living in during 2010? Was there a mortgage on the house in 2010? Did you buy your home in 2010? > Please specify all the costs for the purchase of the house When did you register as inhabitant of this house? Did you sell a former own home in 2010? > Please specify the costs of selling the house When did you unregistered as an inhabitant of this former house? If you have moved into a new home in 2010, how much did you spend on reconstructions? Did you receive a governmental grant for your home in 2010? Did you pay other interest on the house in 2010 (apart from mortgage)? HOME OWNERS...% please enclose the WOZ assessment 2010 please enclose your annual mortgage statement please enclose: Invoice notary, value assessment, defrayment, fin. advice. Date: please enclose: Invoice broker, value assessment, mortgage fine. Date:... s s Did you pay for a lease hold? s Is your home a government listed monument? please enclose: - WOZ assessment - Assessment Waterschaps- en polderlasten - Costs for back maintenance. - Declaration government listed monument Did you rent out (part of) your home in 2010? s Did you buy a new home in 2010, whilst still owning your previous home? (Due to divorce/waiting for sales etc.) When did you unregistered as an inhabitant of your first home? What were the mortgage payments for this second home in 2010? Did you rent out your previous home (temporarily) after you had moved out? (this could also be prior to 2010) Date: please enclose your annual mortgage statement s -BOX 2- SUBSTANTIAL PARTICIPATION Did you own more than 5% of the shares of a company on (personally and/or together with family)? Did you at some point in 2010 own more than 5% of the shares of a company in 2010 (personally and/or together with family)? Did the above ownership originate from a transition of a sole proprietorship business or a partnership? SUBSTANTIAL PARTICIPATION / DIRECTOR-SHAREHOLDER...% please enclose annual accounts please specify purchase & selling prices when did the transition take place? Did you receive dividend payments from this company in 2010? Did this company place property at your disposal or did you or your family place property at the business disposal? If so, were payment made? please specify please specify... info@vanderkloet.nl Page 3
4 -BOX 3- PROPERTY ASSETS & LIABILITIES Please don t forget the accounts in your or in your children s name that were closed in 2010! Initials accountholder (incl. children under 18) Number of Accounts Yearend statements bank- and securities accounts Initials accountholder (incl. children under 18) Policy Number Type of Capital Sum Assurance Annuity, home owners, funeral, life Yearend statements Was Dutch or foreign tax on dividends withheld in 2010? Was any of your money invested in so called Maatschappelijke Beleggingen (societal investments) in 2010? (e.g. green stock or humanitarian investments) Was any of your money invested in so called venture capital in 2010? (i.e. loans to start up firms) Are you a founder of a trust or did you inherit any trust capital in 2010? Other property Description Real estate, but not your own home (e.g. grounds, second home) Right to real estate Investments in movable property (other than for private use) Rights to movable property Debt-claims Other assets Other liabilities than the box 1 mortgage on your own home (please don t forget your creditcards) please enclose WOZ assessment please enclose your annual statements info@vanderkloet.nl Page 4
5 Did you receive any allowances, entitlements, increments or donations in 2010? OTHER & EXPENDITURE Did you receive any Zorgtoeslag or Huurtoeslag in 2010? Did you or any of your children receive an inheritance in 2010? please specify amounts Did you receive income from a trust capital in 2010? please specify amounts Did you receive any kind of education in 2010? Did you receive a scholarship or a student grant in 2010? Did you make any charitable donations in 2010? please specify amounts per donation Were any of your medical costs not compensated (partially) by your healthcare insurance in 2010? Did you pay premium for a disability insurance in 2010? Did you pay premium for annuity in 2010 or before April 1 st 2010? Did you receive any gross payments out of annuity reservations? Did you invest as a limited partner in a Film L.P., Maritime L.P. or in a so called Green Investment L.P. in 2010? Foreign Situations Did you move to or from the Netherlands in 2010? MIGRATION Which period were you living abroad in 2010? In which country? From: In: Untill: Did you earn any income in the other country in 2010? please specify amounts Moving from the Netherlands Did you have a Dutch pensionplan and if so, what was the value on the migration date? Would you like to be insure for the AOW etc on a voluntary basis? Please enclose a statement of all your bank accounts, debts and insurences on the migration date. Moving to the Netherlands Have you lived in the Netherlands before? From: Until: Notes Notes regarding taxreturn info@vanderkloet.nl Page 5
6 Did you enclose everything? Please tick off the boxes to you show that you have included the information : Your Most Recent Estimated Tax Assessment 2010 (Voorlopige Aanslag 2010). Yearend statement daycare (per child) Parental leave statement from your employer Declaration Use of Public Transport (OV-verklaring) Overview of income other than from paid employement or self employement Copy VAR Copy 30% ruling Overview of income and expenses from your business or freelance work in 2010 (Template) Mortgage yearend statement Sale or purchase invoices current or previous home WOZ assessment 2010 WOZ assessment 2011 Specification of costs for a government listed monument Overview allowances, entitlements, increments and donations Overview student grants Enclosed To Follow NA Overview costs for education Enclosed To Follow NA Overview not compensated medical costs Yearend statement disability insurance Yearend statement annuity Overview charitable donations Annual report substantial participation B.V. (if not already with us) Yearend statements bank account, securities accounts & capital sum assurance info@vanderkloet.nl Page 6
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