Claim for Entrepreneurs’ Relief - Section 169M TCGA 1992 When you make a claim as an individual, this will normally ‘you are unable to make a claim in a return you may do be done at the time you make your Tax Return. If however this by completing Section A of this form, If a claim is made by the trustees fa settlement, then it must be made jointly by both the trustees and the: qualifying beneficiary To make the claim using this form the qualfying beneficiary should complete Section Aand the ractccc of the settiement Section 8, Section A Individual/qualifying beneficary Name Mlexandev Willian Rock Address ‘Shenstones,, NG1i3 ons HM Revenue & Customs office Lethians Avea, Edtburgh Tac reference AMLA 40059 Tota ofall previous chargeable gains (ret of alonabe Losses) on which you have came Entrepreneurs Relic either alone - on your own gains - or jointly with trustees, on the trustees gains ail \29 hereby claim under Section 169M TCGA 1952 in respect ofthe dsposl ofthe ase) specified below Section B Trustee of settlement Name Address Postcode HM Revenue & Customs office Tax reference 'f the individual, trustees or qualifying beneficiary have no HMRC office or references, please explain wiy The particulars given in this claim are correctly stated to the best of my/our belief Description of asset oF shaves in Shenstone Sewiees Ltd. State the name and addresses ofall income beneficiaries interested in the settiement asset(s) disposed of Avwl. Ruck (as above > 148275 2009, Date of disposal 0D Mm YYYY eo} of) |zlelels What is each qualifying beneficiaries income entitlement in percentage terms ofthe asset(s) disposed of loo. Pease attach your computation ofthe capital gain on which you are claiming Entrepreneurs Rei and the amount of rei due Page 10