Car provided for the private use of an employee or a director Use from 6 April 2013 onwards
You must complete this form if there is a change that affects car benefits for an employee earning at the rate of 8,500 a year or more, or a director for whom a car is made available for private use. Complete and return this form within 28 days of the end of the quarter to 5 July, 5 October, 5 January or 5 April in which the change takes place.
Employers details
Name
General details
Show here and on Page 2 any changes that have been made.
We provided the employee or director with a car, which is available for private use. We provided the employee or director with a second or further car, which is available for private use. The employee has started to earn at the rate of 8,500 a year or more, or has become a director. We have withdrawn a car provided to the employee or director and have not replaced it. If you ticked this box, please complete the boxes below, and then go straight to the declaration overleaf. Do not complete the other sections. Date withdrawn DD MM YYYY
Phone number
PAYE reference
/
Employees or directors details
Name
National Insurance number
Date of birth (if known) DD MM YYYY Please give details of the car withdrawn. Gender Male Female Make and model
Engine size cc
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P46 (Car)(2013)
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5013588
HMRC 12/12
Details of the car provided:
Make and model
Details of the car provided:
Price and employee contributions Price of the car (not the price actually paid, but the price for tax purposes normally the list price at the date of first registration)
Engine size cc Please tick one of these boxes to show the engine size: up to 1400cc 14012000cc 2001cc or more unknown
0 0
Price of accessories not included in the price of the car
0 0
Date the car was first made available to the employee DD MM YYYY
Date first registered DD MM YYYY Capital contribution (if any) made by the employee towards the cost of the car and for accessories
Emissions Give details of the approved CO2 emissions figure at the date of first registration Grams of CO2 per kilometre If you have not filled in a figure for approved CO2 emissions, please show the reason: car was first registered before 1998, or 1998 or later car, for which there is no approved CO2 emissions figure (for example, some personal imports from outside the European Community)
0 0
Sum that the employee is required to pay (if any) for private use of the car
If so, how often? Weekly Monthly Quarterly Yearly
0 0
Fuel for private use
Type of fuel or power used Key letter use the list of key letters below to find the appropriate key letter and enter it in the box below: Type: Key letter Is fuel provided for private use? Tick 'Yes' if the employee is provided with any fuel at all for private use, including any combination of petrol and gas, or petrol for a hybrid electric car. Do not tick 'Yes' if only electricity is provided. Yes No
Zero emission cars (including electric cars) Diesel cars (all Euro standards) All other cars
E D A
If Yes, must the employee pay for all fuel used for private motoring and do you expect them to continue to do so? Yes No
Declaration
I declare that the information I have given is correct according to the best of my knowledge and belief. Signature
Capacity in which signed
Date DD MM YYYY
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