7. Completing the form US-Individual 2002
Use the following notes to help you complete Parts A to F of form US-Individual 2002.
include on the form only the income on which you are claiming relief from UK tax under the provisions of the
UK/USA Double Taxation Convention
give all the information requested and attach any supporting documents that are asked for, if you need more room,
attach a separate sheet, please write your name and your
HM Revenue & Customs reference number on each
Part A: Personal details of claimant
Please give all the details asked for. If you have a tax adviser, include the tax adviser’s details.
Part B: Questions
Tick the boxes that apply to you and give any additional information asked for.
Question 12 – ‘Conduit arrangement’
Question 12 on form US-Individual 2002 applies if you include in the form US-Individual 2002 interest, royalties or other
income as provided for in the Double Taxation Convention under Articles 11, 12 and 22 respectively. It asks whether any
income to which the claim refers is paid under a ‘conduit arrangement’.
The definition in Article 3(1)(n) of the Double Taxation Convention is as follows:
“(n) the term “conduit arrangement” means a transaction or series of transactions:
(i) which is structured in such a way that a resident of a Contracting State entitled to the benefits of this Convention
receives an item of income arising in the other Contracting State but that resident pays, directly or indirectly, all or
substantially all of that income (at any time or in any form) to another person who is not a resident of either Contracting
State and who, if it received that item of income direct from the other Contracting State, would not be entitled under a
convention for the avoidance of double taxation between the state in which that other person is resident and the
Contracting State in which the income arises, or otherwise, to benefits with respect to that item of income which are
equivalent to, or more favourable than, those available under this Convention to a resident of a Contracting State; and
(ii) which has as its main purpose, or one of its main purposes, obtaining such increased benefits as are available under
Note: Please strike through all unused or partially completed sections.
Part C: Application for relief at source from UK income tax
Give the details asked for in Part C to apply for relief at source from UK income tax on future payments of income. Relief
at source may be available in cases where HM Revenue & Customs is able to exercise its discretion to issue a notice
(under Statutory Instrument 1970 Number 488, as amended). We deal with each application on its merits. Where we
cannot agree to allow relief at source or cannot arrange it, you can claim repayment of the UK income tax taken off.
If relief at source is granted, please tell HM Revenue & Customs at the address in Note 6, without delay,
if there is any subsequent change to the information you have given on the form US-Individual 2002.
C.1: UK State Pension
The UK State Pension is a National Insurance benefit and is taxable, but usually paid without deduction of tax. If you
receive a UK State Pension you can claim exemption from UK income tax under the UK/USA Double Taxation
Convention. Tick the ‘UK State Pension’ box in Part C.1 of the form US-Individual 2002 and give the date
State Pension Deferral lump sum
If you have received a State Pension Deferral lump sum from which UK tax has been taken off, please complete Part C.1
as above and enter in Part D the amount of the lump sum and the amount of tax taken off. Please send with your form
US-Individual 2002 a photocopy of the notification of the lump sum award that you received from The Pension
Service. This will help us make the repayment.
Like the State Pension, Incapacity Benefit is taxable but is paid without deduction of tax. If you receive Incapacity Benefit
you can claim exemption from UK income tax under the UK/USA Double Taxation Convention. Tick the
‘UK Incapacity Benefit’ box in Part C.1 of
the form US-Individual 2002 and give the date payments began.