Luxembourg 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 *




EMPLOYMENT INFORMATION

Year of Employment *
Have you applied for this refund before?
Approximate first date of arrival in Luxembourg *	DD/MM/YYYY
Approximate last date of departure from Luxembourg *	DD/MM/YYYY
Address while in Luxembourg


How many employers did you work for? *


EMPLOYER 1

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began working in Luxembourg	DD/MM/YYYY
Approximate date you finished working in Luxembourg	DD/MM/YYYY
Do you have your Certificat de Remuneration/Certificat de Salaire ou de Pension?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 2

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began working in Luxembourg	DD/MM/YYYY
Approximate date you finished working in Luxembourg	DD/MM/YYYY
Do you have your Certificat de Remuneration/Certificat de Salaire ou de Pension?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 3

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began working in Luxembourg	DD/MM/YYYY
Approximate date you finished working in Luxembourg	DD/MM/YYYY
Do you have your Certificat de Remuneration/Certificat de Salaire ou de Pension?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 4

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began working in Luxembourg	DD/MM/YYYY
Approximate date you finished working in Luxembourg	DD/MM/YYYY
Do you have your Certificat de Remuneration/Certificat de Salaire ou de Pension?	If yes, please fax, scan and email or post to taxback.com today


EMPLOYER 5

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began working in Luxembourg	DD/MM/YYYY
Approximate date you finished working in Luxembourg	DD/MM/YYYY
Do you have your Certificat de Remuneration/Certificat de Salaire ou de Pension?	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 Fiche de Salarie ou de Pension/Fiche de retenue d'Impot from each of your employers (if you have them) - see details on the next page.