   
*041682501*

Tax and Customs Administration
OB  - Z*FOL ENG
Why this form?
Period of your application
Your application must relate to a minimum period of three months
and a maximum period of one calendar year. The refund period may
only be less than three months if it concerns a remaining part of a
calendar year.
Minimum amounts for a refund
The amount for which you request a refund must be at least:
€ 400 if your application relates to a minimum period of three
months, but not a full calendar year.
€ 50 if your application relates to a period of at least 1 calendar year,
or the remaining part of a calendar year.
What should you enclose?
Enclose with your application a statement from your own tax
authorities showing that you are an entrepreneur subject to taxation.
If you have already submitted a statement which is not more than
one year old, there is no need to send a new statement.
In addition, include copies of invoices or import documents.
The documents concerned must show which amounts of

you paid.
The application may relate to one or more invoices or import
documents. We will not return these documents to you.
Refund received erroneously
If you erroneously receive a

refund, you must pay back this amount.
Explanatory notes to the questions
Question b
State the activities in the Netherlands for which you purchased
the goods or services here.
Question c, option three
Exempted transport services are transport services relating to
the transit, export or import of goods. Certain conditions apply
to this exemption.
If you do not have enough space in order to complete the
questions,
you should use an enclosure. The enclosure should
state your name, address, town and your registration number
in the Netherlands.
Explanatory notes
Application
For  refund
For entrepreneurs based in non- countries
As an entrepreneur based in a non- country, you can use this form
to request a refund of  you paid in the Netherlands.
When can you request a  refund?
You can request a  refund if you meet the following conditions:
Your company is based in a non- country.
You want to request a refund of Dutch .
You do not have to file a  return in the Netherlands.
Completing and returning the form
You can make your application in Dutch, English or German. Make
your application within six months after the end of the calendar year
for which you request a  refund.
Send your application for a refund to:
Belastingdienst Buitenland, Afdeling omzetbelasting
Postbus 2865, 6401  Heerlen, Nederland
Privacy
We treat the data of citizens and companies and your privacy with
care. Please visit belastingdienst.nl/privacy and see how we do this.
More information
Visit belastingdienst.nl for more information. Or call the
Tax Information Line Non-resident Tax Issues: +31 55 538 53 85,
open from Monday to Thursday from 8.00 am to 8.00 pm and
on Friday from 8.00 am to 5.00 pm.
Dutch registration number
Do you have a Dutch registration No. Go to belastingdienst.nl and download the form: Registration for entrepreneurs in non-EU countries.
number? In order to request You must first submit this form.
a  refund, you need a Dutch
registration number.
Yes. Registration number
B
   
*041682502*

02 of 09Registration number
B
Details of your company
a Legal name
b Trade name
c Business address
Street and house number
Postcode and town/city
Country
d Telephone number
e E-mail address
Website
f
Would you like to receive correspon-
Yes, proceed to question 2a.
dence at your business address?
No, proceed to question 1g.
g Correspondence address
Name
Street and house number
Postcode and town/city
Country
Business activities
a Activities of your company in
the Netherlands
Registration in your own country
a Tax office where you are
registered in your own country
b Registration number in your
own country
Your application
a Period to which your application
relates (month-year)
to
b Total amount in whole euros for which you are requesting a refund
(in figures). State the details of the refund in section 8.
   
*041682503*

03 of 09Registration number
B
Bank details
a Account number to which you
want the refund to be transferred
Please note! Do not fill in a savings
account here.
Name of account holder
Street and house number
Postcode and town/city
Country
b Name of the bank
c Location of the bank
Country
d BIC of the bank
Other details of the application
a Number of enclosures
Invoices Import documents
b The goods or services for which
I request a  refund have been
used for:
c During the period for which I did not supply any goods or services
request a  refund, I:
only supplied goods or services on which customers have to pay 
Tick whichever is applicable.
only supplied exempted transport services and related services
none of the above
 Signature
Name
Telephone number
Date
Signature
Please write within the box.
   
*041682504*

04 of 09Registration number
B
Summary of the  amounts for the period to which this application relates
Serial
number
Nature of goods or
services
Name,
  and
address of supplier
Date and nr of invoice
or import document
Amount of tax refund
applied for
For official use
only
   
*041682505*

05 of 09Registration number
B
Summary of the  amounts for the period to which this application relates
Serial
number
Nature of goods or
services
Name,
  and
address of supplier
Date and nr of invoice
or import document
Amount of tax refund
applied for
For official use
only
   
*041682506*

06 of 09Registration number
B
Summary of the  amounts for the period to which this application relates
Serial
number
Nature of goods or
services
Name,
  and
address of supplier
Date and nr of invoice
or import document
Amount of tax refund
applied for
For official use
only
   
*041682507*

07 of 09Registration number
B
Summary of the  amounts for the period to which this application relates
Serial
number
Nature of goods or
services
Name,
  and
address of supplier
Date and nr of invoice
or import document
Amount of tax refund
applied for
For official use
only
   
*041682508*

08 of 09Registration number
B
Summary of the  amounts for the period to which this application relates
Serial
number
Nature of goods or
services
Name,
  and
address of supplier
Date and nr of invoice
or import document
Amount of tax refund
applied for
For official use
only
   
*041682509*

09 of 09Registration number
B
Summary of the  amounts for the period to which this application relates
Serial
number
Nature of goods or
services
Name,
  and
address of supplier
Date and nr of invoice
or import document
Amount of tax refund
applied for
For official use
only
Total amount