Tax Return - Personal Income Tax Declaration

1. Tax Year

Date of completing the form *

Select the tax year * Attention! The tax year is the year for which you file your tax returns.

Have you collected or paid advance income tax for the above-mentioned year? *

Yes

No

The amount of the advances

Collected tax in advance

Paid tax in advance

2. Taxpayer's Personal Data

Private individual or company *

Private individual

Company (ZZP or VOF)

Surname and name / Date of birth *

BSN number * Attention! BSN - burgerservicenummer (Dutch social security number).

Citizenship *

Marital status *

Date of divorce *

3. Address and Contact

Street name and number *

Postcode and city *

Country * Attention! If you are registered in the Netherlands, please provide the Dutch address.

Enter country name *

Contact Details

Phone number *

E-mail address *

4. Tax Residence Situation

Were you employed in the Netherlands during the tax year? *

Yes

No

Employment date / from - to: *

Do you need to provide more employment periods? *

Yes

No

Did you receive sickness or unemployment benefit in the Netherlands during the tax year? *

Yes

No

Benefit date / from - to: *

Do you want to add more periods? *

Yes

No

Do you own an apartment or a mortgage in the Netherlands? *

Yes

No

Enter the value of the property or mortgage in euros * (€) Attention! In case of a mortgage in the Netherlands, provide the property value (WOZ) on the last day of the year preceding the tax year.

Street name and apartment number *

Postcode and city of the apartment *

Did you have a municipal registration in the Netherlands (official address) in the tax year? *

Yes

No

Select registration period

5. Taxpayer's Income

Provide the number of tax cards (jaaropgave) in the Netherlands for the tax year * Attention! Jaaropgave (Dutch annual income statement).

Did you have additional income outside the Netherlands in the tax year (e.g. in Poland)? *

Yes

No

Provide the country where you had income *

Provide annual income amount in euros outside the Netherlands *

Did you have capital exceeding 57,000 euros at the end of the tax year? *

Yes

No

Attention! Capital e.g. funds in account, shares, other securities.

Enter amount in € *

Did you incur high medical costs (not covered by insurance)? *

Yes

No

Attention: Own risk (Eigen risico) is not included.

Provide the amount of said costs in euros *

Description (e.g. dentist, diet, medication) *

6. Family Situation and Partner

Do you have children under 18? *

Yes

No

Child 1

Child's name *

Child's date of birth *

Child's BSN

Was the child registered at the same address for min. 6 months? *

Yes

No

Fiscal Partnership

Do you have a spouse or fiscal partner? *

Yes - spouse

Yes - partner

No

Surname and name of spouse/partner *

Date of birth of spouse/partner *

Date of marriage (or year of marriage)

Should we also perform the partner's settlement? *

Yes

No

Attention! If you mark "Yes", providing full partner details below is required.

Partner's Personal Data

Partner's BSN number *

Partner's Citizenship *

Partner's Marital status *

Partner's Address and Contact

Street name and number *

Postcode and city *

Country *

Phone number *

E-mail

Partner's Residence and Income

Was partner employed in NL? *

Yes

No

Number of partner's tax cards (jaaropgave) *

Did partner have income outside NL? *

Yes

No

Did partner have capital >57.000 eur? *

Yes

No

7. Attachments and Consent

Additional information (optional)

Attach required documents

(Use CTRL or CMD to select multiple files)

Required: Jaaropgave, ID copy, optionally mortgage documents. (PDF, JPG) Attention: In case of a mortgage in the Netherlands, you must also attach bank documents! Only PDF and JPG files are accepted (max. 2 MB).

I declare that all information contained in the form is current and true. Mojka Finance bears no responsibility for data discrepancies. I also confirm that I have read and accept the Terms and Conditions.

Signature (First and last name) *