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!

CONTACT DETAILS
( * - mandatory fields )

If you're not sure about a question, put your mouse over the ? for more information.

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 *


For security purposes, please choose a question that we can use to identify you when discussing your tax information *

Answer *


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


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


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 indicate how often you would like us to update you on your tax refund: *
How did you hear about our service? *


more details *



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.