Registered Pension Schemes Relief at Source – annual claim Use for tax year 2017 to 2018 and earlier
Annual claim by Scheme Administrator for recovery of tax deducted by individuals
Account number
Year ending 5 April (enter year)
Sort code
Is this a supplementary claim? No
—
—
If your bank account details change you should give full details in advance of this claim, by writing to Pension Schemes Services, HM Revenue and Customs, BX9 1GH.
Yes
Please complete both pages to reclaim the tax deducted by your members from their relievable pension contributions (including Stakeholder Pension contributions) for tax years 2017 to 2018 and earlier.
External audit
This form should reach us no later than 6 October following the end of the tax year.
Has an external audit been carried out?
Payments can then be made to you on the 21st day of the following month (or the next working day).
No
Go to Claim and statement section on page 2
Detailed guidance about this form can be found in chapter 4 of the Pensions Tax Manual (PTM), go to www.gov.uk/hmrc-internal-manuals/pensions-tax-manual
Yes
Go to External auditor’s report
External auditor’s report We have examined the records of contributions received, kept by
Relief at Source reference number
Scheme Administrator’s details
for the purposes of the Regulation made under Section 192(2) and (3) Finance Act 2004 for the period covered by the annual claim.
Scheme Administrator’s name
In our opinion appropriate records have been maintained by
and the amounts included in Parts 1-6 are in accordance with those records.
Address if your address has changed, or is going to change, please give us your new address
Auditor’s name
Address Postcode Country
Date address changed or will change DD MM YYYY
Postcode Country
Contact name report any changes separately
Signature of appointed auditor
Contact’s phone number Date DD MM YYYY Name of Scheme Administrator’s bank
APSS106 (Pre 2018)
Page 1
HMRC 04/18
Claim and statement
Part 5 Details from interim claims made during the year
Scheme name
Net amount received from HM Revenue and Customs where sum recovered exceeds excess relief payments £
Pension Scheme Tax Reference (PSTR)
E
or
R
Net amount paid to HM Revenue and Customs where excess relief payments exceed sum recovered
Scheme administrators submitting aggregate claims covering multiple schemes don’t need to complete the scheme name or PSTR boxes
£
F
Part 6 Details of amounts now claimed or excess relief repayable
Part 1 Period for which you are claiming
Amount claimed from HM Revenue and Customs G equals C – E, C + F or F – D
From MM YYYY
0 6
£
To MM YYYY
G
Excess relief repayable to HM Revenue and Customs Please enclose cheque. H equals D – F, D + E or E – C
0 5
£
Part 2 Statement of net contributions received and amount claimed
H
Application and certificate
Net contributions received from individuals
I, the Scheme Administrator named overleaf, apply for recovery of the amount shown in Part 6 above.
£
Are any of these contributions as a result of the transfer of an asset or assets in lieu of a cash contribution debt? No
This application is made in accordance with all Regulations made under Section 192(1) Finance Act 2004. I certify that: • All records required by the Regulations are being kept. • The claim relates only to contributions for which relief is given under Section 192(1) Finance Act 2004. • The sum claimed takes account of any interim claim made. • The Scheme Administrator agrees to account to HM Revenue and Customs for any excess amount claimed. • The statements on this form are true and correct in all aspects to the best of my knowledge and belief.
Yes
Nature of assets
Value of assets £
Amount of relief claimed £
A
Name of authorised signatory use capital letters
Part 3 Details of excess relief (schedule attached in accordance with the Regulations)
Signature of authorised signatory
Net contributions received
£
Date DD MM YYYY
Excess relief obtained £
B If the authorised signatory has changed since the last application, please give the details on a separate sheet of paper and send them to us with this form.
Part 4 Net amount claimed A minus B £
C
For more information or help write to us at: Pension Schemes Services, HM Revenue and Customs, BX9 1GH
or Net payment due B minus A £
Help
D
Or phone us on 0300 123 1079 Your rights and obligations Your Charter explains what you can expect from us and what we expect from you. For more information go to www.gov.uk/government/publications/your-charter/ your-charter Page 2