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!

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CONTACT DETAILS
( * - mandatory fields )

Title

First Name *

Middle Name

Surname *

Postal Address *

If student - Field of study. If working - Occupation

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 *


How did you hear about our service? *
What is the name of that person/organisation? *
Year of Employment *


EMPLOYMENT INFORMATION

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 Fiche de Salarie ou de Pension/Fiche de retenue d'Impot?	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 Fiche de Salarie ou de Pension/Fiche de retenue d'Impot?	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 Fiche de Salarie ou de Pension/Fiche de retenue d'Impot?	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 Fiche de Salarie ou de Pension/Fiche de retenue d'Impot?	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 Fiche de Salarie ou de Pension/Fiche de retenue d'Impot?	If yes, please fax, scan and email or post to taxback.com today


I want to provide you with my bank details


Currency of the transfer *
Bank name *
Address of the bank branch *
Branch code *
SWIFT /BIC code *
Personal account number /IBAN for all EU countries/ *
Name of account holder *



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 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.