Tax Rebate Claim Form R38 Client Ref (Office use only) Taxpayer Name National Insurance No. Dear Sir/Madam, I wish to claim tax relief on the expenses of my employment. The details of my employment, the years claimed for, and the expenses relevant to the claim are as follows: Job Title Employer My expenses relate to the following tax years: 2011-12 2012-13 2013-14 2014-15 2015-16 STEP 1) Employment History Please detail your employment history since January 2010. Please enter "PRESENT" under 'Date Ended' if you are still in NHS employment. Employer Job Title Date Started Date Ended STEP 2) Occupation / Uniform Allowance If you wear a uniform at work, are required to wash it yourself, and are not reimbursed for this expense or reimbursed by your employer for cost of laundry, please tick your job title below. STEP 3) Shoes, Stockings & Tights Under EIM67200 - Tax Treatment of Nurses: Expenses Deductions: Shoes & Stockings / Tights allowance Occupation / Job Title Ambulance staff on active service 140/Yr Nurse, Midwife, Chiropodist, Dental Nurse, Occupational / Speech / Other Therapist, Physiotherapist, Phlebotomist, Radiographer 100/Yr Plaster Room Orderly, Hospital Porter, Ward Clerk, Sterile supply worker, Hospital Domestic, Hospital catering staff 100/Yr Laboratory staff, pharmacist, pharmacy assistant 60/Yr All other uniformed staff, Uniformed ancillary staff, Maintenance / Ground staff, Driver, Parking Warden, Security Guard, Receptionist 60/Yr Tick Your Job Occupation / Job Title Stockings & Tights (where you have to wear a certain style or colour) 6/Yr Socks - Male Nurses: where you have to wear a certain colour sock 6/Yr Shoes - where you have to wear a certain style of shoe in the hospital 12/Yr None of the above apply to me Tick if applies Now complete Page 2 overleaf
STEP 4) Tax Refund for Memberships & Subscriptions Historic subscription fee amounts are listed in the attached sheet. You must list the amount paid in the table below in order to claim Membership Body / Type 2011/12 ( s) 2012/13 ( s) 2013/14 ( s) 2014/15 ( s) 2015/16 ( s) Unison Subscriptions RCN Subscriptions Nursing & Midwifery Council Fees Healthcare Professions Council RCM Subscriptions SoR Subscriptions IBMS Subscriptions GDC Fees GphC Fees Other Step 5) Claimant Details Claimant Name Date received by HM Revenue & Customs Address Postcode Email Address Step 6) Tax Rebate Claim I claim repayment of the amount overpaid by me, (for non SA claims the period or year ended must be entered in the box aside). I authorise agent 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 of Client Ref (Office use only) National Insurance No. To receive on my behalf the amount due. SIGN HERE CLAIMANT SIGNATURE >>> DATE By signing the above, the claimant agrees to all of the disclosures made herein; to the 'Terms & Conditions of Service' as listed at Mytaxrebate.net; and to the payment instructions details above. Claimant agrees to assign the overpayment unconditionally to. Now complete Page 3 overleaf
STEP 7) Your Authorisation SIGN HERE >>> 07931270696 1865VG (SA)
REFERENCE TABLE- Professional Body Subscription & Membership Rates (Page 1 of 2) Unison Subscription Rates Weekly Pay Annual Pay Yearly Subscription (2010 to date) < 38.47 Up to 2,000 15.60 38.48 to 96.16 2,001 to 5,000 42.00 96.17 to 153.84 5,001 to 8,000 63.60 153.85 to 211.53 8,001 to 11,000 79.20 211.54 to 269.23 11,001 to 14,000 94.20 269.24 to 326.92 14,001 to 17,000 116.40 326.93 to 384.61 17,001 to 20,000 138.00 384.62 to 480.76 20,001 to 25,000 168.00 480.77 to 576.92 25,001 to 30,000 207.00 579.93 to 673.08 30,001 to 35,000 243.60 > 673.09 Over 35,000 270.00 Royal College of Nursing (RCN) Subscriptions Full Membership 196.85 196.85 194.93 194.93 Concessionary Membership 147.64 147.64 146.20 146.20 Newly Qualified Membership 98.43 98.43 97.47 97.47 Student Membership 10.00 10.00 10.00 10.00 HCA 98.43 98.43 97.47 97.47 HCA Concessionary 49.21 49.21 47.73 47.73 Nursing & Midwifery Council (NMC) Fees Annual Fee 120.00 100.00 100.00 76.00 Fee to register a qualification 25.00 25.00 25.00 25.00 Society of Radiographers (SOR) Fees Full Member 252.00 252.00 249.00 243.00 Overseas Member 123.00 123.00 120.00 117.00 Reduced Rate 173.00 173.00 171.00 168.00 Accredited Assistant 120.00 120.00 117.00 114.00
REFERENCE TABLE- Professional Body Subscription & Membership Rates (Page 2 of 2) Health Care Professions Council (HCPC) (Formerly HCPC) Fees New Member 80.00 80.00 76.00 38.00 Renewal Fee 160.00 160.00 152.00 76.00 Scrutiny Fee 56.00 56.00 53.00 53.00 Readmission Fee 280.00 280.00 191.00 191.00 International / EEC Application Scrutiny Fee 440.00 440.00 420.00 420.00 Grandparenting Scrutiny Fee 440.00 440.00 420.00 420.00 Royal College of Midwives (RCM) Subscriptions Full Membership 244.92 244.92 239.00 239.00 Institute of Biomedical Science (IBMS) Subscriptions Fellow 163.00 156.00 156.00 151.00 Member 133.00 127.00 127.00 123.00 Licentiate 94.00 90.00 90.00 87.00 Registration Fee 20.00 20.00 20.00 20.00 Assessment Fee 30.00 30.00 30.00 30.00 General Dental Council (GDC) Fees Dentist 890.00 576.00 576.00 576.00 Dental Care Professional 116.00 120.00 120.00 120.00 Specialist 345.00 345.00 345.00 345.00 General Pharmaceutical Council (GPhC) Fees Pharmacist 240.00 240.00 240.00 267.00 Pharmacy Technician 108.00 108.00 108.00 120.00 Application Fee 102.00 102.00 102.00 102.00