Fillable HMRC Form SI 2848 2002 income tax relief at source and repayment

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HMRC Form SI 2848 2002 income tax relief at source and repayment

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Form US-Company
United Kingdom/United States of America Double Taxation Convention (SI 2002 Number 2848)
United Kingdom income tax relief at source and repayment
This form is for use by a US Company, Mutual Fund, Pension Scheme, Charitable Organisation or Trust
receiving INTEREST or ROYALTIES arising in the UK.
Please
•
•
•
•
•
•
give all the information requested in this form and attach supporting documents where necessary
use the US-Company Notes at the end of this form to help you. If you need more room, attach a
separate sheet
remember to sign the declaration in Part F, giving details of the capacity in which you sign
• see note 5 in the US-Company Notes about the certification requirements of the US Internal Revenue Service.
If you need help or more information
visit our website: www.hmrc.gov.uk and look for International tax for businesses in the ‘Search’ facility,
or phone us, Our contact numbers are:
+ 44 3000 547584 if calling from outside the UK, or 03000 547584 if calling from the UK
or write to HM Revenue & Customs, Large Business DT Treaty Team, Barkley House, Castle Meadow Road,
Nottingham, England NG2 1BA.
Part A Details of the US claimant and tax adviser (if any)
If the company has a tax adviser or other authorised
person whom HM Revenue & Customs may contact,
please give details below.
Full name of the United States company
_______________________________________________
Adviser’s name
Full registered address (do not use ‘care of’ address)
________________________________________________
________________________________________________
Address
______________________________________________
________________________________________________
________________________________________________
______________________________________________
Phone number _________________________________
Phone number __________________________________
Fax number ___________________________________
Fax number ____________________________________
Your reference (if any)
Reference (if any) or contact name
Please give
• your US Employer’s Identification Number,
• the location of the Service Center where the latest
tax return was filed, and
• the date on which it was filed.
If you file a consolidated tax return in the United States, please give:
• the name of the parent company, and
• its Employer’s Identification Number.
For use by the United States Internal Revenue Service
• Please affix your official stamp and attach form 6166. Then send this form to HM Revenue & Customs,
Large Business DT Treaty Team, Barkley House, Castle Meadow Road, Nottingham, England NG2 1BA.
You may wish to take a copy of this form for your records.
Please ‘
9
‘ Official Stamp
Form 6166 attached.
Part B Questions
Please answer all of the questions in Part B1 then follow the instructions below.
Some questions relate to Article 23 of the Double Taxation Convention.
Part B1
B1.1 Is this the claimant’s first claim of this kind?
If ‘No’, please enter the reference number used before for correspondence (begins ‘13….’).
Yes No
13 ______________
B1.2 Is the claimant
(a) a body corporate, or (a) Yes No
(b) an entity that is treated as a body corporate for United States tax purposes? (b) Yes No
The income to which this question refers is interest, royalties or other income as
provided for in the Double Taxation Convention under Articles 11, 12 and 22 respectively.
B1.3 Is any of the income to which this claim refers paid under, or as part of, a ‘conduit
arrangement’ as defined in Article 3(1)(n) of this Double Taxation Convention?
(See note 8 in the US-Company Notes for further information.)
Yes No
Instructions
If you answered ‘Yes’, to either B1.2(a) or B1.2(b), please go to Part B2.
If you answered ‘No’ to B1.2(a) and B1.2(b), please go to
Part B3 for a Mutual Fund, or
Part B4 for a Pension Scheme, etc., or
Part B5 for a Charitable Organisation, or
Part B6 for a Trust.
Part B2: Claimant is a United States Company
B2.1 Is the company
(a) managed in the United States?
(b) incorporated in the United States?
Yes No
Yes No
B2.2 Is the company liable to United States tax in respect only of income from sources in the
United States or profits attributable to a permanent establishment in the United States?
If ‘No’, go to question B2.3.
If ’Yes’, the company will fall outside the definition of ‘resident of a Contracting State’ in Article 4(1) of
the Double Taxation Convention. Please see the US-Company Notes about Part B of the form and
say on a separate sheet why you believe that the claimant is entitled to relief from UK tax,
notwithstanding that it is not to be considered as a resident of the United States.
Yes No
B2.3 Does the company carry on business through a permanent establishment situated in the
United Kingdom?
If ‘Yes’, is the income that is included in this form attributable to the permanent establishment?
If you answer ‘Yes’, please say on a separate sheet why the company believes that it is entitled to
relief from UK tax. (See Article 11(3) and Article 12(3) of the Double Taxation Convention)
Yes No
Yes No
B2.4 Is there any relationship between the company and the UK payer of the income,
other than that of payee and payer?
If ‘Yes’, give full details on a separate sheet.
Yes No
Part B2 (continued)
B2.5 Is the principal class of shares of the company listed or admitted to dealings on a recognised
stock exchange in either the UK or the United States?
(See Article 23(2)(c)(i) of the Double Taxation Convention)
If ‘Yes’, go to question B2.6.
If ‘No’, go to question B2.7.
Yes No
B2.6 Are those shares regularly traded on a recognised stock exchange?
(See Article 23(2)(c)(i) of the Double Taxation Convention)
If ‘No’, go to question B2.7.
Yes No
Only answer this question if you have answered ‘No’ to either Question B2.5 or B2.6.
B2.7 Are shares representing at least 50% of the aggregate voting power and value of the company
owned directly or indirectly by five or fewer companies whose shares are quoted on a recognised
stock exchange in either the UK or the United States?
(See Article 23(2)(c)(ii) and Article 23(7)(a)(I) and (ii) of the Double Taxation Convention)
If ‘Yes’, give on a separate sheet the full names and registered addresses of all the direct and
intermediate shareholders, stating the name of the stock exchange on which the shares are quoted.
If ‘No’, go to question B2.8.
Yes No
Only answer this question if you have answered ‘No’ to Question B2.7.
B2.8 On at least half the days of the taxable period, was at least 50% of the voting power and value
of the shares owned by persons who separately qualify for benefits under the Double Taxation
Convention? (See Article 23(2)(c)(ii) and Article 23(2)(f)(i) of the Double Taxation Convention)
If ‘Yes’,
• give on a separate sheet the full names and registered or residential addresses of those
‘qualified persons’ and
• answer question B2.9.
If ‘No’, and the company considers itself to be a ‘qualified person’ for the purposes of
Article 23 (3) or (4) of the Double Taxation Convention, say why, on a separate sheet.
Yes No
B2.9 In respect of the company's gross income for that taxable period, please ‘9’ as appropriate the
box next to whichever of the following statements is true:
Less than 50% of the company’s gross income was paid or accrued directly or indirectly to persons
who are not residents of either the UK or the United States.
50% or more of the company’s gross income was paid or accrued directly or indirectly to persons
who are not residents of either the UK or the United States.
(See Article 23(2)(f)(ii) of the Double Taxation Convention)
Part B3: Claimant is a United States Mutual Fund
(See Article 23(2)(d) of the Double Taxation Convention)
B3.1 Is the principal class of units in the mutual fund listed or admitted to dealings on a recognized
stock exchange in either the UK or the United States?
If ‘Yes’, go to question B3.2.
If ‘No’, go to question B3.3.
Yes No
B3.2 Are those units regularly traded on a recognised stock exchange?
If ‘No’, go to question B3.3.
Yes No
B3.3 Are the direct or indirect owners of at least 50% of the beneficial interests in the mutual fund
qualified persons by reason of Article 23(2)(c)(i) or 23(2)(d)(i)?
If ‘No’, say on a separate sheet why the mutual fund is a ‘qualified person’ for the purposes of
Article 23(2) or is otherwise entitled to benefit under the terms of this Double Taxation Convention.
(See note 8 in the US-Company Notes for further information.)
Yes No
Part B4: Claimant is a United States Pension Scheme, etc.
(See Article 23(2)(e) and Article 4(3)(a) and (b) of the Double Taxation Convention)
B4.1 Is the claimant a pension scheme?
If ‘Yes’, go to question B4.5.
If ‘No’, go to question B4.2.
Yes No
B4.2 Is the claimant a plan, scheme, fund, trust, company or other arrangement established in the
United States?
If ‘No’, say on a separate sheet why the claimant is a ‘qualified person’ for the purposes of Article
23(2) or is otherwise entitled to benefit under the terms of this Double Taxation Convention.
Yes No
B4.3 Is the plan, scheme, fund, trust, company or other arrangement operated exclusively to
administer or provide employee benefits?
If ‘No’, say on a separate sheet why the claimant is a ‘qualified person’ for the purposes of Article
23(2) or is otherwise entitled to benefit under the terms of this Double Taxation Convention.
Yes No
B4.4 Is the plan, scheme, fund, trust, company or other arrangement exempt from income taxation
in the United States?
If ‘Yes’, go to question B4.5.
If ‘No’,
• give details on a separate sheet.
• then go to question B4.5.
Yes No
B4.5 Are more than 50% of the beneficiaries, members or participants of the pension scheme or
plan, etc., individuals who are residents of either the UK or the United States?
If ‘No’, give details on a separate sheet.
Yes No
Part B5: Claimant is a United States Charitable Organisation
(See Article 23(2)(e) and Article 4(3)(c) of the Double Taxation Convention)
B5.1 Is the organisation established exclusively for religious, charitable, scientific, artistic, cultural or
educational purposes?
If ‘Yes’, go to question B5.2.
If ‘No’,
• give details on a separate sheet.
• then go to question B5.2.
Yes No
B5.2 Is the organisation resident in the United States according to its laws?
If ‘Yes’, go to question B5.3.
If ‘No’,
• give details on a separate sheet.
• then go to question B5.3.
Yes No
B5.3 Is the organisation exempt from tax on its income under the laws of the United States?
If ‘No’, give details on a separate sheet.
Yes No
Part B6: Claimant is a United States Trust
(See Article 23(2)(g) of the Double Taxation Convention)
B6.1 Is at least 50% of the beneficial interest in the trust held by persons who are
‘qualified persons’ by reason of Article 23(2) (a), (b), (c)(i), (d)(i), or (e) of the
Double Taxation Convention?
If ‘Yes’,
• give, on a separate sheet, the full names and residential addresses of the beneficiaries
(or registered addresses if not individuals) and the nature and extent of their interest in the trust
• then go to question B6.3.
If ‘No’, go to question B6.2.
Yes No
B6.2 Is at least 50% of the beneficial interest in the trust held by persons who are ‘equivalent
beneficiaries’ as defined at Article 23(7)(d) of the Double Taxation Convention?
If ‘Yes’,
• give, on a separate sheet, the full names and residential addresses of the beneficiaries
(or registered addresses if not individuals) and the nature and extent of their interest in the trust
• then go to question B6.3.
If the answers to questions B6.1 and B6.2 are both ‘No’, say on a separate sheet why the trust
qualifies for benefits under the terms of this Double Taxation Convention. Then go to question B6.3.
Yes No
B6.3 Was less than 50% of the gross income arising to the trust in the taxable period(s) covering the
income shown on this form paid or accrued, directly or indirectly, to persons who are not residents of
either the UK or the United States?
If ‘No’, say on a separate sheet why the trust qualifies for benefits under the terms of this
Double Taxation Convention.
Yes No
Part C Application for relief at source from UK income tax
Complete Part C1, C2 or C3 as appropriate to apply on behalf of the company for relief at source from UK income tax.
Part C1 Interest from loans
• Answer the question and complete the columns below.
• Attach a copy of the loan agreement for each loan. See below about syndicated loans.
‘9’ as appropriate
Does any part of the loan arrangement fall within the provisions of Article 11(5)(a) of this
Double Taxation Convention?
Yes No
If ‘Yes’, do you consider that Article 11(5)(b) of the Double Taxation Convention applies to this loan?
If you do, please say why on a separate sheet.
Yes No
Name and address of the UK payer of the interest. Date of the
loan agreement
Amount of
the loan
Due date(s) of
the interest
If possible, please also give the name of a contact dealing with the
interest payments.
Syndicated loans - additional information
If the debt right is part of a syndicated loan, please ‘’9’ here
and give the following additional details:
• the amount of your participation
• the total loan facility
• the date of the original loan agreement.
If you are aware that a copy of the loan agreement has already been sent to HM Revenue Customs, there is no need to
attach another copy.
Part C2 Interest from UK securities
Complete the columns below, giving the information requested.
Amount and Name and address in which
security is registered
Registrar’s account number Due date(s) of
the interest
full title of security or reference
Part C3 Royalties
Answer the question and complete columns (a) to (c) below as appropriate, giving the information requested.
Is the claimant company the originator of the work or product that has been licensed to the UK?
‘9’ as appropriate
Yes No
If ‘No’, please attach a copy of the licence, contract or assignment under which the rights sub-licensed to the UK payer
have been acquired from the originator.
For copyright royalties on literary, dramatic,
musical or artistic works
• Enter in column (a) a full description of the royalties.
• Enter in column (b) the date of the licence agreement
between the company and the UK payer.
• Enter in column (c) the payer’s name and address.
If possible, please also give the name of a contact dealing
with the royalty payments.
If payments are made through or by an agent in the UK,
also enter the agent’s name and address.
For other royalties
• Enter in column (a) a full description of the royalties
• Enter in column (b) the date of the licence
agreement between the company and the UK payer
and attach a copy of the licence agreement.
• Enter in column (c) the name and address of the
UK payer of the royalties. If possible, please also give
the name of a contact dealing with the royalty
payments.
Column (a) Column (b) Column (c)
Part D Claim for repayment (where appropriate)
• If the company or concern has received payments of income with UK tax deducted, give details below to claim
repayment of the appropriate amount of UK income tax. If no payments of the income have yet been made, go direct
to the Declaration in Part F.
• For a claim to repayment of tax deducted from interest paid on a loan to a UK resident company or individual,
attach a copy of the loan agreement. See also the note in Part C1 about the additional information we need for
syndicated loans.
Please answer the following question if the claim is for repayment of UK tax on loan interest.
(See the US-Company Notes about Part D)
Does any part of the loan arrangement fall within the provisions of Article 11(5)(a)
of the Double Taxation Convention?
If ‘Yes’, do you consider that Article 11(5)(b) of the Double Taxation Convention applies to this
loan? If your answer is ‘Yes’, please say why on a separate sheet.
Yes No
Yes No
Source of income
For example ‘Copyright royalties paid by [name of payer]’
Date
of payment
of income
Amount of income
before UK tax
£
Amount of
UK tax deducted
£
Totals
Part E Repayment instructions
Complete this part if you want us to make the repayment to a bank or other nominee. If you leave this part empty, the
repayment will be made direct to the company at the address you have shown in Part A of this form.
(Enter your full name)
I,
as
(Enter status - for example, company secretary, treasurer, or authorised agent)
of
(Enter name of the claimant company or concern)
authorise the bank or other nominee below to receive the amount due on the company's behalf.
Name of bank or other nominee
Address of bank or other nominee
Postal code
Account name
Account number
UK bank sort code
(if appropriate)
Nominee's reference number (if there is one) for the company.
Signature ____________________________________ (Now also complete and sign the Declaration in Part F below)
click to sign
signature
click to edit
Part F Declaration
IMPORTANT: Please read note 3 in the US-Company Notes before completing the declaration.
‘
9
’ as appropriate
1. The information I have given on this claim/application is, to the best of my knowledge and belief,
correct and complete
2. I have considered the guidance on beneficial ownership published at INTM332040 by HM Revenue & Customs
and have concluded that
the company or unincorporated concern is beneficially entitled to the income from the source(s)
included in this form or otherwise meets the conditions for relief in the Double Taxation Convention
between the United Kingdom and the United States
(a)
or
the company or concern is not the beneficial owner of the income but is entitled to relief from
UK tax under the Double Taxation Convention for the reason(s) I have given in the attached note.
(b)
On behalf of the company or concern
3. I apply for relief at source from UK income tax and undertake to tell HM Revenue & Customs if there is any change
to the information that I have given in this form. (See the notes about Part C.)
4. I claim repayment of UK income tax and
(a) have worked out that the amount payable *£
to the company or concern is
or
(b) want HM Revenue & Customs to work out the amount payable to the company or concern.
Signature* ______________________________________________________ Date _______________________
Print your name below and enter your status.
*Who may sign:
For a company or fund, a responsible officer of the company or fund may sign. An agent (tax adviser), ‘custodian’ or
other duly authorised person acting with the authority of the company may also sign on the company’s behalf.
For a partnership, the senior, general or managing partner (as appropriate) may sign in the name of the partnership.
Please see note 4 and attach to the form a list giving the names and residential addresses (or registered business
addresses if companies) of all the partners, and each partner’s percentage share in the partnership.
For use by HM Revenue & Customs
Amount repaid:
Examined _________________________________________________ £ _______________________ : ____
HMRC date stamp
Authorised ________________________________________________
©
Crown copyright 2014
*Enter the amount repayable that you
have worked out. Leave the box empty if
you want HM Revenue & Customs to work
out the amount.
click to sign
signature
click to edit
RAFT - 15 AU02
US-Company Notes
Use these Notes to help you complete form US-Company. If you need further information, please contact
HM Revenue & Customs Large Business DT Treaty Team. Our address, phone and fax numbers are in note 7.
1. Purpose of form US-Company
Form US-Company enables
• a US company
• an unincorporated concern such as a mutual fund, pension scheme, charitable organisation or trust in the
United States
receiving interest and/or royalties arising in the United Kingdom to apply for relief at source from UK income tax under
the United Kingdom/United States Double Taxation Convention (SI 2002 Number 2848). The form may be used to claim
relief in respect of any other income qualifying under Article 22 of the Convention – the ‘Other Income’ article. It also
provides for a claim to repayment of UK income tax in cases where payments of the income have been made with UK tax
deducted.
2. Tax vouchers
There is no need to send tax vouchers with the completed form US-Company, but you should keep them in case they are
needed later to support it. You can send the vouchers if you think they will help us deal with the claim.
3. Beneficial ownership
The UK/USA Double Taxation Convention provides for relief to be available to the beneficial owner of the income.
Where a claimant is required to pass on the income in respect of which the claim is made it may not be the beneficial
owner of the income for the purposes of the Double Taxation Convention. Please see the HM Revenue & Customs
guidance published in our International Manual (INTM). To read the guidance online go to www.hmrc.gov.uk and look
for INTM332040 in the ‘Search’ facility.
Where the company or concern does not satisfy the ‘international fiscal meaning’ of beneficial ownership but believes
that because of the policy statements that are made in the guidance it is still able to obtain treaty benefits, you should
• tick box 2(b) in the declaration in Part F of the form
• include with the claim a note giving the information mentioned at INTM332070, under the heading ‘Applications to
HM Revenue & Customs’ – reproduced below for ease of reference:
‘Where structures are within the ambit of the Indofood decision, that is to say the structure has the accessing of treaty
benefits as one of its effects, it is possible that applications to HM Revenue & Customs for benefits under a Double
Taxation Convention (DTC) will fall at the first hurdle unless the applicant can demonstrate beneficial ownership. The
application might simply be regarded as invalid and never reach the stage where it can be considered in terms of the
object and purpose of the particular DTC under which the application is made.
However, where the claimant Special Purpose Vehicle (SPV) does not satisfy the “international fiscal meaning” of
beneficial ownership but believes that it is still able to obtain treaty benefits because of the policy confirmed in this
guidance, it should make its claim and include a note to that effect. To ease consideration of the claim, the note should
include full details as to
• A full structure diagram and explanation of the capital and interest flows;
• why the SPV is considered to be the beneficial owner within the “international fiscal meaning”; or
• demonstrate that the structure does not abuse the DTC under which the claim is made either relating the structure to
the examples at INTM332080 or otherwise.’
Where a claim/application for relief from UK tax is made by a partnership or other concern that is not a taxable person or
is otherwise ‘transparent for tax purposes’ under the law of the United States, you should tick box 2(b) in the declaration
in Part F of the form US-Company and provide additional information as outlined in the HMRC guidance at INTM335500.
4. Claims on behalf of partnerships and LLCs
US partnerships and LLCs should complete the form US-Company as follows:
Parts A and B1 in full
Part C in full, as appropriate
Part D if repayment of UK tax is claimed
Part E if appropriate
Part F in full, with the general or managing partner/member signing the declaration.
The following additional information is also needed:
• Where the partnership or LLC is established in the United States and all of the partners/members are resident for tax
purposes in the United States, attach to the claim a list of the names and addresses of the partners/members. The list
should show residential addresses for individuals and registered addresses where the partners/members are
companies.
• Where any partner/member is resident for tax purposes in a country other than the United States, attach the list
described above. The list must also include for each member/partner their respective percentage share of the income
that is the subject of the claim. Any partner/member resident for tax purposes outside the United States should make
a separate claim to relief from UK tax under the terms of any relevant DTC. The Digest of Double Taxation Treaties
lists all of the UK’s comprehensive DTCs. To read the DT Digest online go to www.hmrc.gov.uk and look for
DT Digest in the ‘Search’ facility.
5. Residence in United States and where to send the completed form
It is a condition of relief from UK income tax under the terms of the Double Taxation Convention that the beneficial
owner of the income is resident in the United States. In making this claim, which needs the certification of the
US Internal Revenue Service, you are consenting to the transmission of a US Form 6166 for the applicant/claimant to
HM Revenue & Customs in the UK.
Send the completed claim form with the US Form 8802, Application for United States Residency Certification, and
the applicable user fee to:
Internal Revenue Service
P.O. Box 71052
Philadelphia, PA 19176-6052
The Application for U.S. Residency Certification and its instructions are available at www.irs.gov
6. Text of the UK/USA Double Taxation Convention
To read the full text of the Convention (SI 2002 Number 2848) online, go to www.hmrc.gov.uk and enter Tax treaties in
the ‘Search’ box. On the page that opens, click the ‘Tax treaties’ link and then click ‘Tax treaties in force’. At the next
page click ‘U’, then under ‘USA’ click the link to ‘2001 USA-UK Double Taxation Convention (Consolidated Version)’.
This will open a PDF file of the Convention.
7. Help or more information
If, after using these Notes you need help or more information, please
• visit our website www.hmrc.gov.uk and look for International tax for businesses in the Search facility
• or phone HM Revenue & Customs Large Business DT Treaty Team + 44 3000 547584 if calling from outside the UK,
or 03000 547584 if calling from the UK
• or write to HM Revenue & Customs, Large Business DT Treaty Team, Barkley House, Castle Meadow Road,
Nottingham, England NG2 1BA
Our fax number is + 44 3000 564002 from outside the UK, or 03000 564002 from the UK.
Please quote our reference number (for example ‘13/A/123456’) whenever you contact us.
8. Completing the form US-Company
Part A: Details of the company or concern and tax adviser
Please give all the details asked for. If the company or concern has a tax adviser, include the tax adviser's details.
All the information that you provide to HM Revenue & Customs is confidential. We can therefore only discuss the tax
affairs of the company or concern with
• an officer of the company
and/or
• any tax adviser or agent who is nominated by the company or concern.
We cannot disclose to the UK payer of the income or their tax adviser any information relating to the claimant company or
concern.
Part B: Questions
• For all claimants – please answer the questions in Part B1
• If you answered ‘Yes’, to either B1.2(a) or B1.2 (b), go to Part B2.
• If you answered ‘No’ to B1.2(a) and B1.2(b), go to
- Part B3 for a Mutual Fund, or
- Part B4 for a Pension Scheme, etc., or
- Part B5 for a Charitable Organisation, or
- Part B6 for a Trust.
Part B2, question B2.2
This note applies only if you answer ‘Yes’ to question B2.2
Relief from UK tax is available under the Double Taxation Convention only to residents of the United States.
If you answer ‘Yes’ to question B2.2, you are saying that the claimant company or concern is liable to United States tax in
respect only of income from sources in the United States or profits attributable to a permanent establishment in the
United States, and this will mean that the company does not meet the definition of ‘resident of a Contracting State’ found
at Article 4(1) of the Double Taxation Convention (most typically, where the claimant is a branch of a non-US enterprise).
If answering “Yes” please therefore detail on a separate sheet why you believe that the claimant is entitled to relief from
UK tax, notwithstanding that it is not to be considered as a resident of the United States.
Article 23 of the Double Taxation Convention and the questions in Part B of the form
In order to be able to benefit from the Double Taxation Convention the claimant is required to be a ‘qualified person’,
(as defined in Article 23 of the Double Taxation Convention) or if not a ‘qualified person’, then fulfil certain other tests in
respect of an item of income whose source is in the UK. The questions in Part B of the form seek to establish whether
the claimant is a qualified person or otherwise entitled to the benefits of the Double Taxation Convention.
If you are claiming that relief from UK tax should be allowed under the terms of Article 23(6) of the DTC you should
complete this claim form and send it in the normal way to the United States Internal Revenue Service (See Note 5).
At the same time, you should write to HM Revenue & Customs, Business International Tax Treaty Team,
100 Parliament Street, Westminster, London, England SW1A 2BQ. Your letter should clearly state that you are asking
the "competent authority" of the United Kingdom to deal with your claim under the terms of Article 23(6) of this treaty.
A copy of your letter to the competent authority should be attached to the claim form US-Company.
‘Conduit arrangement’
Question B1.3 on form US-Company 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
this Convention.”
Part C: Application for relief at source from UK income tax
Relief at source from UK income tax on future payments of income 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 part or all of the UK tax taken off, as appropriate. The declaration in Part F of form
US-Company includes an undertaking to tell HM Revenue & Customs if there is any change to the information that you
have given on the form.
Parts C1 and C2: UK Interest
Interest from loans
Where the interest is payable on a loan to a UK resident company or individual, please attach a copy of the
loan agreement to the form US-Company.
If the debt right is part of a syndicated loan, please
• give the additional information asked for in Part C1 of the form
• attach a copy of the loan agreement, unless you are aware that a copy has already been sent to
HM Revenue & Customs. If so, there is no need to attach another copy.
Interest from securities
UK tax is deducted from interest on loan stocks issued by
• companies which are not quoted on the Stock Exchange and
• local authorities.
that is paid to persons who are outside the UK. As explained above we may be able to arrange for interest on these
stocks to be paid with no UK tax deducted.
Interest from the following UK sources is paid with no UK tax deducted, so there is no need to apply for relief from UK tax
at source. Please do not enter in Part C2 of form US-Company
• interest from company loan stocks quoted on the Stock Exchange (paid automatically without deduction of UK tax)
• interest from UK government securities (paid automatically without deduction of UK tax).
Part C3: UK Royalties
The Double Taxation Convention allows relief only to the beneficial owner of the royalties. The beneficial owner is
normally the originator of the work or product.
• Copyright royalties for literary, dramatic, musical or artistic works
If your company or concern is not the originator but has acquired the rights, please attach to the form US-Company a
copy of the licence, contract or assignment under which the UK rights have been acquired. This will help HMRC to check
that the beneficial ownership condition in the Double Taxation Convention is satisfied. If your company or concern is in
the publishing or music business and uses a standard form of contract with all its authors or composers, please attach a
copy of the standard contract. You need do this only the first time a form US-Company is completed.
• Other royalties
Where your company or concern is the originator of a process or design etc., please attach to the form US-Company a
copy of the licence agreement between yourselves and the UK payer of the royalties. If your company or concern is not
the originator of the product giving rise to the royalties but has acquired the rights, please also attach a copy of the
licence, contract or assignment under which the UK rights have been acquired.
Part D: Claim for repayment
Repayment of UK income tax deducted from interest on
• a loan arrangement within the provisions of Article 11(5)(a) of the Double Taxation Convention where
• payments of interest have already been made
Where a loan arrangement falls within the provisions of Article 11(5)(a) of the Double Taxation Convention and Article
11(5)(b) does not apply, UK tax is retained at the rate of 15% of the gross amount of the interest, as provided for in
Article 10(2)(b). The remaining balance of UK income tax is repayable.
If you are claiming repayment of UK income tax deducted from interest on a loan that is within the provisions of Article
11(5)(a), please use the boxes below to work out the amount of the repayment. If you do not wish to work out the
repayment and do not enter an amount at Part F.4(a) of the form US-Company, HMRC will work out any repayment due.
Gross Interest UK tax
• Enter in box 1 the gross amount of interest (i.e. before deduction
of any tax) and in box 2 the full amount of UK tax deducted
1 £
2
£
• Calculate 15% of the gross amount of interest (in box 1) and enter it in box 3.
3 £
• Deduct the amount in box 3 from the amount in box 2 and enter the result in box 4.
4 £
• Finally, take the amount you have shown in box 4 and enter it in the box provided at Part F.4(a) of form US-
Company. This is the amount repayable.
Part E: Repayment instructions
You should only complete Part E if you want HM Revenue & Customs to make any repayment to a bank,
tax adviser or other person on the company's or concern's behalf.
If you want repayment to be made to the company's tax adviser, please give the reference number (if any) that the
tax adviser uses.
You must also sign the declaration at Part F if you sign the authorisation in Part E.
Part F: Declaration
The declaration in Part F should be completed and signed after reading note 3 ‘Beneficial ownership’ in these Notes.
Who may sign:
• For a company or fund, a responsible officer of the company or fund may sign. An agent (tax adviser), ‘custodian’ or
other duly authorised person acting with the authority of the company may also sign on the company’s behalf.
• For a partnership, the senior, general or managing partner (as appropriate) may sign in the name of the partnership.
Please see note 4 for further information.
These notes are for guidance only and reflect the UK tax position at the time of writing. They do not affect any rights of appeal.
© Crown copyright 2014
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HMRC Form SI 2848 2002 income tax relief at source and repayment

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Completed 22 February 2020

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