HMRC: Structured Email

*indicates required information

Completing this form

Only complete this form if all the following apply:

You need authorisation urgently.
You are a registered intermediary organisation.
You have an Office Identification Number, given to you by HM Revenue & Customs (HMRC).
The customer has asked you to act on their behalf for their tax credits and/or Child Benefit claim.
The customer has agreed that HMRC may give information to you/your organisation.
You hold a form TC689 signed by the customer and also their partner for a joint tax credits claim.

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Customer details

Last name:*

First name(s):*

Address line 1:*

Address line 2:*

Address line 3:

Postcode:*

Date of birth:*

dd/mm/yyyy

If the customer has no UK National Insurance number, please enter 'NONE' in the field below.

National Insurance number:*

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Partner details (joint tax credits claims)

Last name:

First name(s):

Address line 1:

Address line 2:

Address line 3:

Postcode:

Date of birth:

dd/mm/yyyy

If the customer's partner has no UK National Insurance number, please enter 'NONE' in the field below.

National Insurance number:

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Intermediary details

Name of organisation:*

Office Identification Number:*

Contact name of intermediary:*

Address line 1:*

Address line 2:*

Address line 3:

Postcode:*

Intermediary telephone number:*

Intermediary email address:*

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Tax credits/Child Benefit authority

You must complete one or both checkboxes below to show which claim or claims your authority applies to.

Tax credits

Child Benefit

Child Benefit Number:

Date of customer's signature on form TC689:*

dd/mm/yyyy

The authority will last for 12 months from the date of signature unless you give a different date in writing.

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Intermediary declaration

I declare that:

I hold a form TC689 signed by the customer and also their partner for a joint tax credits claim
I agree to retain the form TC689 for seven years from the date I submit this form and understand that I may be asked to provide it at any time

Please tick the checkbox below to confirm your agreement.

I agree with the above declaration*

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After you click the 'Next' button you will see a preview page summarising the information you have provided. If this page is not displayed, please use the scroll bar to locate any missing or incorrect entries highlighted in red.

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TC689 - Tax credits and Child Benefit urgent authorisation for an intermediary to act on your client's behalf

Completing this form

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Customer details

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Partner details (joint tax credits claims)

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Intermediary details

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Tax credits/Child Benefit authority

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Intermediary declaration

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