Belgium Tax Refund Application

Please fill out this simple form with as much information as possible - it will take just 4 minutes! Once you complete this form, our representative will contact you within 8 hours!

Use secure connection (SSL)

CONTACT DETAILS
( * - mandatory fields )

Title

First Name *

Middle Name

Surname *

Postal Address *

Email address *

Phone number *

Line Type *

Country Code *

Area Code *

Phone number *

Please send confirmation via SMS to this number

Date of Birth *

DD/MM/YYYY

Which country are you from? *


State *
City *


How did you hear about our service? *
What is the name of that person/organisation? *


ADDITIONAL INFORMATION

Have you ever filed a tax return with the Belgian Tax Authorities for this year before?
If yes, do you currently have your Notice of Assessment?
If yes, please (scan and email, fax or post a copy) to taxback.com today.
Approximate first date of arrival in Belgium *	DD/MM/YYYY
Approximate last date of departure from Belgium *	DD/MM/YYYY
Address while in Belgium


If student - Field of study. If working - Occupation
National Insurance Number (if you know it)
How many employers did you work for? *
NOTE: Please only select the number of employers that you received wages from.


EMPLOYER 1

Company Name
Full Business Address


If you worked for a recruitment agency, the name of your consultant (if known)
Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your Fiche 281.10/Loonfiche 281.10 (tax card)?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 2

Company Name
Full Business Address


If you worked for a recruitment agency, the name of your consultant (if known)
Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your Fiche 281.10/Loonfiche 281.10 (tax card)?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 3

Company Name
Full Business Address


If you worked for a recruitment agency, the name of your consultant (if known)
Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your Fiche 281.10/Loonfiche 281.10 (tax card)?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 4

Company Name
Full Business Address


If you worked for a recruitment agency, the name of your consultant (if known)
Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your Fiche 281.10/Loonfiche 281.10 (tax card)?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 5

Company Name
Full Business Address


If you worked for a recruitment agency, the name of your consultant (if known)
Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your Fiche 281.10/Loonfiche 281.10 (tax card)?	If yes, please fax, scan and email or post to taxback.com today

I want to provide you with my bank details


Currency of the transfer *
Bank name *
Address of the bank branch *
Branch code *
SWIFT /BIC code *
Personal account number /IBAN for all EU countries/ *
Name of account holder *



Have you also worked in any of the following countries? to select multiple options, hold down the control key while selecting
Did you receive a tax refund?

YOUR FEEDBACK AND ADDITIONAL INFORMATION
Please enter any additional comments and information here:

Please read our terms and conditions and indicate that you accept them in order for your registration to proceed
Yes, I accept the Terms and Conditions *

DON'T FORGET-IMPORTANT!
Once you hit submit you will need to send us your Loonfiche 281.10/Fiche 281.10 from each of your employers (if you have them) - see details on the next page.