Company Name Ltd

Dividend on

[SHARE VALUE AND CLASS]

Tax Voucher

Interim /
Final		Period
Ending	Record
Date	Payment
Date		Net £
per share	

BENEFICIARY	

Holding		Tax Credit		Dividend
Payable	

This voucher should be retained, as it will be accepted by HM Revenue & Customs as evidence of tax credit at 10% in respect of which you may be entitled to claim relief.

[COMPANY SECRETARY]
Secretary
[DIRECTOR]
[ADDRESS]
Registered Office: [ADDRESS]

Registered in United Kingdom
Registered [DATE]
Company Number [COMPANY NUMBER]