ABD vergi iadesi başvuruları ve çek bozdurma işlemleri İlgili Makama

=Katılımcı Beyanı=
Konu: ABD vergi iadesi başvuruları ve çek bozdurma işlemleri
İlgili Makama:
Katıldığım Amerikan J1 programı çerçevesinde Amerikan makamlarına ödemiş
olduğum vergilerimden, ABD Yasaları gereği alabileceğim iadelerle ilgili
bireysel hakkımın olduğunu, bu işlemde StudyZone’un hiçbir yetki / sorumluluk
ya da muhataplığının bulunmadığını, StudyZone’un web sitesindeki ilanın,
katılımcınınsahip olduğu bu imkanı hatırlatma babında yayınlandığını, katılımcı
olarak, bu gibi işlemleri yakından bilen StudyZone’danyardım istemem halinde
hiçbir ücret almaksızın genel bilgi veren StudyZone’un sorumluluğunun
bulunmadığını, vergi iade firmalarının bana örnek mahiyette sayılanlarla sınırlı
olmadığını ve bu firmayı tamamen kendi araştırmalarım neticesi
belirleyeceğimi / belirlediğimi ve sonraki aşamalarda ilgili vergi iade firmasıyla
görüşmelerimi doğrudan yapacağımı bilir ve kabul ederim.
ABD Yasalarının sağladığı hakla ilgili işlemlerde tek muhatabımın resmi daire
ile aracı vergi iadesi firması olduğunu bilmekte ve bu bilgi çerçevesinde
hareket etmekteyim. Olası hiçbir sorunda StudyZone’un sorumlu olmadığını ve
çözümleri ile alakalı muhatap, etki ve/veya yetki sahibi olmadığını bilir, kabul
eder ve aksini iddia etmeyeceğimi taahhüt ederim. Amerikan çeklerimin
bozdurulması ile ilgili işlemlerde de tek muhatabımın aracı vergi iadesi firması
olduğunu bilmekte ve bu bilgi çerçevesinde hareket etmekteyim. Olası
hiçbir sorunda StudyZone’un sorumlu olmadığını ve çözümleri ile alakalı
muhatap, etki ve/veya yetki sahibi olmadığını bilir, kabul eder ve aksini iddia
etmeyeceğimi taahhüt ederim.
Ad-Soyad :_________________________
İmza
:__________________________
Tarih
:__________________________
YYusa00GLD03b
AGREEMENT ON REPRESENTATION IN A TAX REFUND PROCEDURE
(hereinafter referred to as the Agreement)
this Agreement is concluded and entered into by and between these parties:
DENDAX INTERNATIONAL LLC
2817 SE 115th Ave, Portland, Oregon, 97266 USA
Oregon Business Registry Number: 104265194
(hereinafter referred to as Dendax)
Full Name:__________PAUL TESTER___________________Ad
dress:TESTING STREET 25, 15000 PRAGUE, CZECH
REPUBLIC_________________
Date of birth:___22.05.1990_______________________
(hereinafter referred to as the Client)
@
PREAMBLE
Dendax is a company doing business in accounting and documentary advisory and especially arrangement of tax refund for third parties.Client
wishes to use services provided by Dendax, as (s)he believes there is a valid tax refund claim.
Dendax hereby agrees to arrange for this Client all these steps leading to the filing of the tax report and of the tax refund application in dependance
of the destination specified below:
United States
1. Inform the Client as to all support documentation needed for filing of the report and refund application.
2. Prepare, print, sign on behalf and send the tax report based on support documentation provided by the Client.
3. Represent the Client before tax authorities and during all communication in the process. For this reason all official client communication shall be routed
through Dendax.
4. After registration at Dendax the Client shall obtain a user account (user + password) in a proprietary online application developed.
5. Dendax shall secure the tax refund for the Client to be paid to a bank account of Dendax and then within 14 days shall inform the Client as to the
receipt of the tax refund. This information shall be sent to the Client's email and shall appear in as Dendax Money.
This information shall include the following data:
● total refund received
● total fee
6. Dendax shall send the refund to a bank account selected by the Client within 7 days since the moment the Client chooses to get the refund wired in
Dendax Money while stating bank details. If the bank account to which the Client wishes the refund to be wired does not belong to the Client, the
Client shall first be asked to sign an affidavit. Then the refund shall be wired within 7 days since the moment Dendax receives the affidavit.
7. If the tax authority requests any further support documentation, Dendax shall immediately inform the Client.
8. If during the refund procecure it turns out the Client owes tax for previous periods or terms, Dendax shall immediately inform the Client.
The Client hereby agrees, confirms and stipulates:
1. The Client hereby empowers Dendax to perform the steps described above.
2. The Client hereby states that (s)he has not filed the tax report or requested tax refund from said country for the periods or terms in question and has not
empowered any other person or party to do that for him/her.
3. Upon signing this Agreement consents to give and hand over all documents needed for the filing of the tax report, and also states that all of the supplied
documents and provided information is true.
4. The Client confirms that (s)he is aware that the fees connected with these services of Dendax shall be cleared against the received tax refund.
5. If the Client receives the tax refund from a source that is not Dendax (i.e. from another company or from the tax authority itself), the Client agrees to
immediately pay the costs connected with the services already provided by Dendax.
6. If the Client owes tax for another period or term and the tax authority clears the tax debt against the accepted tax refund claim, the Client agrees to to
immediately pay the costs connected with the services already provided by Dendax in respect of every tax year for which Dendax filed the tax return
for this Client. If the debt is not paid in full upon said debt clearing, the Client hereby agrees to pay the tax debt and the costs connected with the
payment of the tax debt (namely drafting relevant documentation, filing it, bank fees).
7. The Client is aware that the final decision as to the tax refund in up to the tax authority in question and that what Dendax will provide is as precise an
estimate as possible and available with respect to the final tax refund given the current tax laws and information that is available for that destination,
whereas Dendax cannot be responsible or liable for the actual refund sent by the tax authority.
8. The Client understands Dendax is an agent, a link between the tax payer and the tax authority, whereas Dendax cannot be responsible or liable for any
delays in the tax refund procedure.
9. The Client shall immediately inform Dendax about any changes regarding his/her contact information or information or data or materials supplied for
the tax refund procedure such as corrected versions of documents from employers etc.
SAMPLE
Notice of termination
Either party hereto may deliver or hand over to the other party a written notice of termination. If the Client terminates this Agreement while Dendax
has already filed the tax report, the Client agrees to pay Dendax its fee connected with the services provided under this Agreement.
Fee
1. The fee that this Client shall pay to Dendax for the service of preparation and filing of the tax report and the tax refund application is 84 USD for tax
refund lower then 500 USD or 89 USD for refund of 501 USD or higher.
2. If Dendax has to take other steps (especially payment of tax de ts, drafting and filing appeals or complaints or otherwise challenging in written thereso
lutions as to tax de ts from previous terms or periods, requesting documents from employers, etc.), Dendax shall state its fee for those steps in advancb
e and shall first inform the Client a out that.b
Final provisions
1. This Agreement will be construed in accordance with, and its performance will be governed by, the laws of the State of Oregon
without regard to its conflict of law provisions.
2. Any disputes arising from this Agreement or performance hereunder shall be resolved by the courts of the State of Oregon.
Date:
DENDAX INTERNATIONAL LLC
Name of the signatory
Ivo Brabec
Date
03. 10. 2015
Client
John Tester
Signature:
@
YURTDIŞINDA ÖDENEN VERGİLERİN İADESİ TALEBİNE İLİŞKİN İŞLEMLER İÇİN TEMSİL SÖZLEŞMESİ
(„Sözleşme”) İşbu sözleşme, kimlik bilgileri aşağıda yazılı olan kişiler arasında düzenlenmiştir: DENDAX INTERNATIONAL LLC
2817 SE 115th Ave, Portland, Oregon, 97266 USA
Oregon Business Registry Number: 104265194
(Bundan sonra sözleşme içerisinde “Dendax” olarak
anılacaktır)
Isim:_______________________________________
Adres:_______________________________________
Doğum Tarihi:_______________________________________
(Bundan sonra sözleşme içerisinde “Müşteri” olarak anılacaktır.)
SÖZLEŞMENİN AMACI
Dendax, muhasebe ve evrak danışmanlığı konularında faaliyette bulunmakta olan bir firma olup, özellikle müşterileri adına üçüncü taraflardan vergib
iadesi alınması talebi konusunda gerekli işlemlerin takibini yürütmektedir. Müşteri vergi iadesi almak için gerekli şartların oluştuğunu dikkateb
alarak, Dendax firmasının hizmetlerinden yararlanmak istemektedir.
İş bu sözleşme ile Dendax firması, Müşteri adına aşağıda belirtilen ülkelerde vergi iadesi alınması talebine ilişkin işlemler doğrultusunda vergib
beyannamesi düzenlemeyi ve gerekli mercilere sunmayı üstlenmektedir:
United States
1. Dendax, vergi iadesi alınması talebine ilişkin vergi beyannamesinin düzenlenmesi ve gerekli mercilere sunulması için gerekli tüm evraklar konusunda Müşteriyi
bilgilendirir;
2. Dendax, Müşterinin firmaya beyan ettiği evraklar doğrultusunda, vergi beyannamesini düzenler, yazıcıdan çıktısını alır, müşteri adına beyannameyi imzalar ve
gerekli mercilere sunar;
3. Dendax, bu işlemler süresince tüm vergi makamları ile yapacağı gerekli iletişim, görüşme ve yazışmalarda Müşteriyi temsil eder. Bu nedenle Müşterinin tüm
resmi iletişim, görüşme ve yazışmalarını Müşteri adına Dendax yapacaktır;
4. Müşterinin, Dendax tarafından geliştirilen sisteme kaydından sonra Müşteri şahsına ait online uygulamalardan yararlanabileceği bir kullanıcı hesabına (kullanıcı
ismi + şifre) sahip olacaktır. (Bundan sonra sözleşme içerisinde „Dendax Money”);
5. Dendax, Müşteri adına yapılacak vergi iadelerinin kendi banka hesabına yapılmasını talep edecek olup, 14 (on dört ) iş günü içerisinde Müşteriye göndereceği
e-mail ile tarafına banka havalesi ile yapılan ödeme konusunda Müşteriyi bilgilendirecektir. Müşteriye gönderilen e-mail aşağıdaki bilgileri içerecek olup
„Dendax Money” başlığını taşıyacaktır:
● İadeye ilişkin yapılan toplam ödeme tutarı
● Toplam kesintiler
6. Veri iade işleminin tamamlanmasından sonra iade konusu tutar Dendax tarafından Müşteriye „Dendax Money” aracılığı ile e-mail yoluyla iletilecektir.
Müşterinin e-mailde belirtilen tutarı ve banka hesabı bilgilerini „Dendax Money” aracılığı ile onaylamasından sonra 7 (yedi) iş günü içerisinde Dendax,
Müşteri’nin banka hesabına vergi iade tutarını havale edecektir. Müşteri tarafından Dendax’a verilen banka hesap bilgilerinde hata veya yanlışlık olması
durumunda, Müşteri Dendax ofisine davet edilerek affidavit-taahhüt ( yazılı yeminli beyan ) imzalaması talep edilecektir. Müşterinin affidavit-taahhüt ( yazılı
yeminli beyan ) imzalamasından sonra 7 (yedi) iş günü içerisinde Dendax, Müşteri’nin banka hesabına vergi iade tutarını havale edecektir.
7. Vergi mercilerinin ek evrak istemeleri durumunda Dendax, en kısa sürede Müşteri’yi bilgilendirecektir.
8. İade işlemleri sırasında Müşteri’nin önceki dönemlere ait vergi borçlarının olduğunun anlaşılması durumunda Dendax, en kısa sürede Müşteri’yi
bilgilendirecektir.
SAMPLE
İşbu sözleşme ile Müşteri aşağıdaki şartlara uymayı taahhüt ettiğini beyan ve kabul eder:
1. Yukarıda konu edilen işlemler için Dendax’ı vekil tayin etmektedir;
2. Müşteri sözleşmede bahsi geçen ülke ve tarih aralığı için vergi iadesine ilişkin vergi beyannamesi vermediğini, bu işlemler için başka bir şahıs veya kurumu
onun adına işlem yapması için velik tayin etmediğini beyan ve kabul etmektedir.
3. İşbu sözleşmenin imzalanması ile Müşteri, vergi iadesine ilişkin vergi beyannamesinin düzenlenmesi ve gerekli mercilere verilmesi için gerekli tüm evrakları
Dendax’a beyan ve teslim edeceğini ve yine tüm evrakların ve bilgilerin doğruluğunu beyan ve kabul etmektedir;
4. Müşteri, Dendax’ın kendisine sağlayacağı hizmetlerin ücret ödemesinin, veri iadesi tutarından karşılacağını kabul ve taahhüt etmektedir;
5. Müşterinin söz konusu vergi iadesini Dendax haricinde başka bir kanal ile ( başka bir firma veya direkt vergi makamları ) tahsil etmesi durumunda, Müşteri
Dendax’ın bu süre zarfında söz konusu hizmete ilişkin yapmış olduğu masrafları Dendax’a ödemeyi kabul ve taahhüt etmektedir.
6. Müşterinin söz konusu vergi iadesini Dendax haricinde başka bir kanal ile (başka bir firma veya direkt vergi makamları) tahsil etmesi durumunda, Müşteri
Dendax’ın bu süre zarfında söz konusu hizmete ilişkin yapmış olduğu masrafları Dendax’a ödemeyi kabul ve taahhüt etmektedir.
7. Müşterinin başka tarih aralığı ve sürede vergi borcunun olması durumunda ve vergi makamlarının vergi iade talbine konu olan tutar üzerinden ödenecek vergi
hesaplamaları durumda, Müşteri en kısa sürede Dendax’ın Müşteri adına o zamana kadar yapmış olduğu hizmetlere (Dendax’ın Müşteri adına her vergi yılına
ait vergi beyannamenin verilmesi) ait masrafları ödemeyi kabul ve taahhüt etmektedir. Vergi borcuna konu olan tutarın zaman aşımına mahal vermeden
ödenmemesi durumunda, işbu sözleşme ile Müşteri vergi borcunun ödenmesi ve ödemeye ilişkin masrafların ( ilgili evrakların hazırlanması, teslim edilmesi,
banka masrafları ) tarafından karşılacağını kabul ve taahhüt etmektedir.
8. Müşteri, vergi iadesi tutarına ilişkin nihai kararın tamamen yetkili vergi otoritelerinin takdirinde olduğunu, Dendax tarafından yapılan tahmini hesaplamanın
söz konusu ülkeye ait nihai vergi iadesine ilişkin geçerli vergi kanunları ve güncel bilgiler doğrultusunda mümkün olan en doğru hesaplama olduğunu, veri
makamları tarafından yapılmasına karar verilen vergi iade tutarından Dendax’ı sorumlu tutmayacağını kabul ve taahhüt etmektedir.
9. Müşteri, Dendax’ın vergi mükellefleri ve vergi mercileri arasında bir acenta olduğunu, vergi mercilerinden kaynaklanan vergi iade sürecinin uzamasından
Dendax’ın sorımlu olmadığını kabul ve taahhüt etmektedir.
10. Müşteri, vakit kaybetmeden mümkün olan en kısa sürede firma bilgilerinde veya vergi iadesine ilişkin belgelerde ve bilgilerde oluşabilecek değişiklikler
konusunda Dendax’ı bilgilendireceğini kabul ve taahhüt etmektedir (işverenler tarafından belgelerin düzeltilmiş versiyonları ve vb.).
SÖZLEŞMENİN SONA ERMESİ
Taraflardan her biri, karşı tarafa yazılı olarak bildirmek veya elden teslim etmek şartı ile aralarındaki işbu sözleşmeyi feshedebilirler. Dendax’ın vergi
beyannamesini gerkli mercilere tesliminden sonra Müşteri’nin sözleşmeyi feshedmek istemesi durumunda Müşteri sözleşme konusu hizmetlerin karşılığı
olan ücreti Dendax’a ödemeyi kabul eder.
ÜCRETİN TUTARI VE ÖDEME ŞEKLİ
1. Müşteri, vergi kaydı için hazırlıkların yapılması ve gerekli mercilerde kaydın yapılması, vergi aidesi talebinin yapılması hizmetlerinin karşılığında Dendax’a
ücret ödeyecek. Müşteri tarafından Dendax’a ödenecek yapılacak ücret vergi iade talebinin: Eğer iade miktar 1-500 USD arasındaysa 84 USD , eğer iade miktarı
501 USD veya üzerindeyse 89 USD kesinti yapılacaktır.
2. Dendax, sözleşme sürecinde vereceği hizmet ile bağlantılı olarak Müşteri adına gerekli gördüğü işbu sözleşme konusu olmayan faaliyetlerde bulunması b
durumunda, Müşteriyi önceden bilgilendirecek ve yapılan harcamalar için Müşteriye belge beyan edecektir. (vergi borçlarına ilişkin ödemeler, şikayet veya redb
dilekçelerinin düzenlenmesi ve verilmesi, önceki dönem ve sürelere ait vergi borçlarına ilişkin yazılı olarak itirazda bulunma,işverenden evrak talebinde b
bulunma ve vb.)
ÖZEL HÜKÜMLER
1. İşbu sözleşme Oregon Eyaleti yasalarına uygun olarak düzenlenmiş olup, aynı kanun hükümleri ile çelişkiye mahal vermeden Oregon
Eyaleti yasalarına tabi olacaktır.
2. İşbu sözleşmeden kaynaklanacak olan her türlü uyuşmazlık ve görüş ayrılıklarının ve ğın çözümünde Oregon Eyaleti Mahkemeleri
yetkilidir.
SAMPLE
YYusa00GLD04b
COLLECTION AGREEMENT
This Collection Agreement (hereinafter referred to as the Agreement) is concluded and entered into by these Parties (hereinafter jointly referred to as the Parties and each
individually as the Party)
DENDAX INTERNATIONAL LLC
Oregon Business Registry No. 104265194
Registered address: 2817 SE 115th Ave, Portland, Oregon, 97266 USA
(hereinafter referred to as the Agent)
@
John Tester
Full name:_______________________________________
22. 5. 1990
Date of birth:_______________________________________
Testing Street 25, 140 00 Prague, Czech republic
Current residence address:_______________________________________
US SSN:_______________________________
1234-567895
(hereinafter referred to as the Principal)
1. The Principal and the Agent have entered into an agreement pursuant to which the Agent shall provide receivables administration services (hereinafter referred to as the
Receivables). Receivables will be refunded to the Principal in a form of cheque. Cheques will be drawn in the name of the Principal or the Agent, who provides cheques
collection and related services (hereinafter referred to as the Cheque), as the nominee of the Principal, or by a direct bank transfer;
2. The Parties wish to agree on the terms and conditions of the collection of the Cheque. For the purposes of implementation of this Agreement, the Agent will use personal
data, bank account details and other information of the Principal submitted to the Agent by this Principal.
3. In accordance with the terms and conditions set forth in this Agreement, the Agent shall provide to the Principal cheque collection and related services (hereinafter
referred to as the Services) and the Principal shall accept said Services and remunerate this Agent for those Services rendered.
4. The Parties hereby agree that the Agent will act and shall be indicated in all related documents as the nominee to receive the Cheque and/or other kinds of payments on
behalf of the Principal. Once the Cheque is received by the Agent, the Agent shall submit the cheque for collection to a bank selected by the Agent. The submission shall
be made not later than within 15 (fifteen) days after the receipt of the Cheque or other receivables.
5. The Cheque or other payments received shall be collected on a special bank account of the Agent. The collected money and/or amounts received from third parties shall
be accounted separately from the funds of the Agent. The Parties agree that these amounts are owned by the Principal and are held in the account of the Agent for the
benefit of the Principal in accordance with this Agreement until the transfer of the amounts due to the Principal in accordance with this Agreement. These amounts shall
not be considered income of the Agent and, unless agreed otherwise, the Agent shall not be entitled to use the collected money for his own needs.
6. If according to this agreement, the Principal does not provide required Principal’s personal data including bank account information for completion of the Services
within 1 (one) year from the date the last signature was attached underneath this Collection Agreement, the Agent shall deduct its service fee and (if applicable) additional
bank charges. This shall be deemed and considered a proper and full performance of the obligations of the Agent set forth in this Agreement and the Agent shall not be
held liable for any further claims against the amounts concerned.
7. The money received after collection of the Cheque or received directly from any third party shall be refunded to the Principal after deduction of the fee for Services in
accordance with this Agreement, and the service fee payable by the Principal to the Agent from any other agreements, and (if applicable) additional bank charges under,
and shall be paid by a bank transfer.
SAMPLE
8. The Agent shall bear the cost of one bank transfer. However, the Agent shall not be responsible for (i) any fees charged by the Principal’s bank or intermediary bank; or
(ii) for any additional bank charges if the bank needs to repeat the transfer because of the incorrect or incomplete information provided by the Principal. Where the
receivable amount is converted from one currency to another, it shall be calculated in accordance with the exchange rate applied by the respective bank in effect on the day
of conversion for the purposes of the bank transfer to be made to the Principal’s bank account.
9. While providing the Services the Agent shall, where necessary, disclose that he is acting as the nominee of the Principal and the collection of the Cheque or other
payments received and transfer of money is made in the name and on behalf of the Principal.
10.
The fee for the Services (hereinafter referred to as the Service Fee) shall be a fixed amount of 15 EUR for each cheque issued to the Principal in accordance with
the terms and conditions of this Agreement.
11.
The Service Fee shall be deducted from the amount received after collection of the Cheque or from the other payments received, prior to the transferring it to the
Principal’s bank account.
12.
This Agreement is in legal force once the last signature is attached hereunder and shall be in legal force until the last moment of the performance of the obligations
of the Parties set forth herein. This Agreement may be terminated by a written mutual agreement of the Parties.
13.
The Principal has the right to unilaterally terminate the Agreement, which must be done in written form, only until the moment the Agent has started to perform
hereunder, otherwise the Agent will complete the Services hereunder, to the extent possible, and shall have a right to make the deductions described herein.
14.
The Agent is a US company. The cheques hereunder are sent by US authorities. This Agreement is thus executed in English language. An electronic copy of this
Agreement shall be provided to the Principal after it is signed by the Agent. All and any amendments to this Agreement shall be in written form, dated and numbered, and
signed by both Parties.
15.
This Agreement shall be governed by the laws of the State of Oregon, while any dispute arising from or in connection with this Agreement shall be resolved by the
courts of the State of Oregon.
Date:
DENDAX INTERNATIONAL LLC
Name of the signatory
Ivo Brabec
Date:
Client
Signature:
3. 10. 2015
John Tester
@
YYusa00GLD05b
AGREEMENT ON REPRESENTATION IN A TAX REFUND PROCEDURE
(hereinafter referred to as the Agreement)
this Agreement is concluded and entered into by and between these parties:
John Tester
Full Name:_______________________________________
DENDAX INTERNATIONAL LLC
Testting street 25, 1400 Prague, Czech Republic
Address:_______________________________________
2817 SE 115th Ave, Portland, Oregon, 97266 USA
Date of birth:_______________________________________
Oregon Business Registry Number: 104265194
22. 05. 1990
(hereinafter referred to as the Client)
(hereinafter referred to as Dendax)
PREAMBLE
Dendax is a company doing business in accounting and documentary advisory and especially arrangement of tax refund for third parties.Client
wishes to use services provided by Dendax, as (s)he believes there is a valid tax refund claim.
Dendax hereby agrees to arrange for this Client all these steps leading to the filing of the tax report and of the tax refund application in dependance
of the destination specified below:
United States
1. Inform the Client as to all support documentation needed for filing of the report and refund application.
2. Prepare, print, sign on behalf and send the tax report based on support documentation provided by the Client.
3. Represent the Client before tax authorities and during all communication in the process. For this reason all official client communication shall be routed
through Dendax.
4. After registration at Dendax the Client shall obtain a user account (user + password) in a properly developed online application.
5. Dendax shall secure the tax refund for the Client to be paid to a bank account of Dendax and then within 14 days shall inform the Client as to the
receipt of the tax refund. This information shall be sent to the Client's email and shall appear in as Dendax Money.
This information shall include the following data:
● total refund received
● total fee
6. Dendax shall send the refund to a bank account selected by the Client within 7 days since the moment the Client chooses to get the refund wired in
Dendax Money while stating bank details. If the bank account to which the Client wishes the refund to be wired does not belong to the Client, the
Client shall first be asked to sign an affidavit. Then the refund shall be wired within 7 days since the moment Dendax receives the affidavit.
7. If the tax authority requests any further support documentation, Dendax shall immediately inform the Client.
8. If during the refund procedure it turns out the Client owes tax for previous periods or terms, Dendax shall immediately inform the Client.
The Client hereby agrees, confirms and stipulates:
SAMPLE
1. The Client hereby empowers Dendax to perform the steps described above.
2. The Client hereby states that (s)he has not filed the tax report or requested tax refund from said country for the periods or terms in question and has not
empowered any other person or party to do that for him/her.
3. Upon signing this Agreement consents to give and hand over all documents needed for the filing of the tax report, and also states that all of the supplied
documents and provided information is true.
4. The Client confirms that (s)he is aware that the fees connected with these services of Dendax shall be cleared against the received tax refund.
5. If the Client receives the tax refund from a source that is not Dendax (i.e. from another company or from the tax authority itself), the Client agrees to
immediately pay the costs connected with the services already provided by Dendax.
6. If the Client owes tax for another period or term and the tax authority clears the tax debt against the accepted tax refund claim, the Client agrees to
immediately pay the costs connected with the services already provided by Dendax in respect of every tax year for which Dendax filed the tax return
for this Client. If the debt is not paid in full upon said debt clearing, the Client hereby agrees to pay the tax debt and the costs connected with the
payment of the tax debt (namely drafting relevant documentation, filing it, bank fees).
7. The Client is aware that the final decision as to the tax refund in up to the tax authority in question and that what Dendax will provide is as precise an
estimate as possible and available with respect to the final tax refund given the current tax laws and information that is available for that destination,
whereas Dendax cannot be responsible or liable for the actual refund sent by the tax authority.
8. The Client understands Dendax is an agent, a link between the tax payer and the tax authority, whereas Dendax cannot be responsible or liable for any
delays in the tax refund procedure.
9. The Client shall immediately inform Dendax about any changes regarding his/her contact information or information or data or materials supplied for
the tax refund procedure such as corrected versions of documents from employers etc.
Notice of termination
Either party hereto may deliver or hand over to the other party a written notice of termination. If the Client terminates this Agreement while Dendax
has already filed the tax report, the Client agrees to pay Dendax its fee connected with the services provided under this Agreement.
Fee
1. The fee that this Client shall pay to Dendax for the service of preparation and filing of the tax report and the tax refund application is:84 USD for tax
refund lower then 500 USD or 89 USD for refund of 501 USD or higher.
2. If Dendax has to take other steps (especially payment of tax debts, drafting and filing appeals or complaints or otherwise challenging in written thereso
lutions as to tax debts from previous terms or periods, requesting documents from employers, etc.), Dendax shall state its fee for those steps inbadvanc
e and shall first inform the Client about that.b
Final provisions
1. This Agreement will be constructed in accordance with, and its performance will be governed by, the laws of the State of Oregon
without regard to its conflict of law provisions.
2. Any disputes arising from this Agreement or performance hereunder shall be resolved by the courts of the State of Oregon.
YYusa00GLD06b
ABD Vergi Paketi
KİŞİSEL BİLGİLER
Adınız:
Baba adınız:
Soyadınız:
John
Doğum tarihi:
Tester
/ 05
22
Medeni Durum (birini
işaretleyin):
X
Evli / Bekar
/ 1990
POSTA KODU
Ülke:
Şehir:
Sokak:
Testing Street 25
Istanbul
Türkiye
PK:
Vatandaşlık:
Türk
14000
İLETİŞİM BİLGİLERİ
Cep telefonu:
Ev telefonu:
+90123456789
+90 234 555 666
E-mail adresi:
john.tester@testing.test
VERGİ BİLGİLERİ
Hangi ülkeden vergi
iadesi?
Hangi yıl/llar için
başvurmak
istiyorsunuz: 2015
Daha önce vergi iadesi için başvurdunuz mu?
(birini işaretleyin)
Evet /XHayır
SAMPLE
ABD
Şu anda ülkedemisiniz? (daire içine alınız)
Tekrar ziyaret etmeyi düşünüyormusunuz? (birini
daireleyin)
Hayır / Evet, 3 ay içinde / Evet,
3 yıl içinde
X
X / Hayır
Evet
SSN (Social Security Number):
Kalış süresi:
Ülkeye yaklaşık giriş tarihi:
Ülkeden yaklaşık ayrılma tarihi:
Işveren sayısı:
05
29
06
/
/ 09
2015
/
/ 2015
1
İŞVEREN BİLGİLERİ
İşveren 1:
Mc Employer
İşveren 2:
Şirket adı:
Emloyer Stree25c, New York, NY 58852
Şirket adı:
Çalışma dönemi:
Çalışma dönemi:
itibaren:
kadar:
06
25
/
/
06
09
/
/
2015
2015
itibaren:
kadar:
/
/
/
/
Lütfen adınızı latin harfler ile kimliğinizde yazılı olduğu gibi yazınız.
YYusa00GLD08b
DENDAX Jemnická 1138/1
140 00 Praha 4
Czech Republic EUROPE
Individual Income tax, FICA
State Income tax
+420226809115
+420212244009
X
1040series, 843, 8233, 8316, 2015-2014-2013-2012-2011
3911, 4506, 8822, 14039, Claim
for refund,Request for Abatement
2015-2014-2013-2012-2011
X
@
12345
Form
2848
(Rev. July 2014)
Department of the Treasury
Internal Revenue Service
Part I
1
OMB No. 1545-0150
Power of Attorney
and Declaration of Representative
▶
For IRS Use Only
Received by:
Information about Form 2848 and its instructions is at www.irs.gov/form2848.
Name
Power of Attorney
Telephone
Caution: A separate Form 2848 must be completed for each taxpayer. Form 2848 will not be honored
for any purpose other than representation before the IRS.
Function
/
Date
/
Taxpayer information. Taxpayer must sign and date this form on page 2, line 7.
Taxpayer name and address
Taxpayer identification number(s)
Daytime telephone number
Plan number (if applicable)
hereby appoints the following representative(s) as attorney(s)-in-fact:
2
Representative(s) must sign and date this form on page 2, Part II.
Name and address
DENDAX Jemnicka 1138/1, 140 00 Praha 4, Czech Republic,
EUROPE
Check if to be sent copies of notices and communications
X
CAF No.
PTIN
Telephone No.
Fax No.
Check if new: Address X
Telephone No.
Fax No.
Telephone No.
Fax No.
CAF No.
Name and address
Check if to be sent copies of notices and communications
X
PTIN
Telephone No.
Fax No.
Check if new: Address
CAF No.
PTIN
Name and address
SAMPLE
Telephone No.
(Note. IRS sends notices and communications to only two representatives.)
Name and address
Fax No.
Check if new: Address
Telephone No.
Fax No.
CAF No.
PTIN
Telephone No.
Fax No.
Check if new: Address
Fax No.
Telephone No.
(Note. IRS sends notices and communications to only two representatives.)
to represent the taxpayer before the Internal Revenue Service and perform the following acts:
3
Acts authorized (you are required to complete this line 3). With the exception of the acts described in line 5b, I authorize my representative(s) to receive and
inspect my confidential tax information and to perform acts that I can perform with respect to the tax matters described below. For example, my representative(s)
shall have the authority to sign any agreements, consents, or similar documents (see instructions for line 5a for authorizing a representative to sign a return).
Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower,
Practitioner Discipline, PLR, FOIA, Civil Penalty, Sec. 5000A Shared Responsibility
Payment, Sec. 4980H Shared Responsibility Payment, etc.) (see instructions)
Income and FICA Tax
Tax Form Number
(1040, 941, 720, etc.) (if applicable)
1040 series, 843, 8233, 8316, 3911, 4506, 8822,
14039, Claim for refund, Request for Abatement
State Income Tax
Year(s) or Period(s) (if applicable)
(see instructions)
2015-2014-2013-2012-20111
2015-2014-2013-2012-2011
4
Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded on CAF,
▶
check this box. See the instructions for Line 4. Specific Use Not Recorded on CAF . . . . . . . . . . . . . . .
5a
Additional acts authorized. In addition to the acts listed on line 3 above, I authorize my representative(s) to perform the following acts (see
instructions for line 5a for more information):
x Authorize disclosure to third parties;
x Substitute or add representative(s); x Sign a return;
This power of attorney is being filed persuand to Reg. Sec. 1.6012-1 (a)(5), which requires a Power of Attorney to be attached to return if a return is signed by an
agent by reason of continous absence from U.S. for 60 days prior to the due date of return
x Other acts authorized:
Representative is authorized to SIGN tax return, to RECEIVE any correspondence, to ENDORSE refund check, represemtative
may delegate another representative to be of another for me. This power of attorney is being filed pursuant to regulations 1.6012 (a)(s) by reason of
continuous absence
For Privacy Act and Paperwork Reduction Act Notice, see the instructions.
Cat. No. 11980J
Form 2848 (Rev. 7-2014)
Page 2
Form 2848 (Rev. 7-2014)
b
6
Specific acts not authorized. My representative(s) is (are) not authorized to endorse or otherwise negotiate any check (including directing or
accepting payment by any means, electronic or otherwise, into an account owned or controlled by the representative(s) or any firm or other
entity with whom the representative(s) is (are) associated) issued by the government in respect of a federal tax liability.
List any specific deletions to the acts otherwise authorized in this power of attorney (see instructions for line 5b):
Retention/revocation of prior power(s) of attorney. The filing of this power of attorney automatically revokes all earlier power(s) of
attorney on file with the Internal Revenue Service for the same matters and years or periods covered by this document. If you do not want
to revoke a prior power of attorney, check here . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
Signature of taxpayer. If a tax matter concerns a year in which a joint return was filed, each spouse must file a separate power of attorney
even if they are appointing the same representative(s). If signed by a corporate officer, partner, guardian, tax matters partner, executor,
receiver, administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer.
7
▶
IF NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF ATTORNEY TO THE TAXPAYER.
03. 10. 2015
@
John Tester
Part II
Signature
Date
Print Name
Declaration of Representative
Title (if applicable)
Print name of taxpayer from line 1 if other than individual
Under penalties of perjury, by my signature below I declare that:
• I am not currently suspended or disbarred from practice before the Internal Revenue Service;
• I am subject to regulations contained in Circular 230 (31 CFR, Subtitle A, Part 10), as amended, governing practice before the Internal Revenue Service;
• I am authorized to represent the taxpayer identified in Part I for the matter(s) specified there; and
• I am one of the following:
a Attorney—a member in good standing of the bar of the highest court of the jurisdiction shown below.
b Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below.
c Enrolled Agent—enrolled as an agent by the Internal Revenue Service per the requirements of Circular 230.
d Officer—a bona fide officer of the taxpayer organization.
e Full-Time Employee—a full-time employee of the taxpayer.
f Family Member—a member of the taxpayer’s immediate family (for example, spouse, parent, child, grandparent, grandchild, step-parent, stepchild, brother, or sister).
g Enrolled Actuary—enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the authority to practice before
the Internal Revenue Service is limited by section 10.3(d) of Circular 230).
h Unenrolled Return Preparer—Your authority to practice before the Internal Revenue Service is limited. You must have been eligible to sign the
return under examination and have prepared and signed the return. See Notice 2011-6 and Special rules for registered tax return preparers
and unenrolled return preparers in the instructions (PTIN required for designation h).
i Registered Tax Return Preparer—registered as a tax return preparer under the requirements of section 10.4 of Circular 230. Your authority to
practice before the Internal Revenue Service is limited. You must have been eligible to sign the return under examination and have prepared and
signed the return. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolled return preparers in the
instructions (PTIN required for designation i).
k Student Attorney or CPA—receives permission to represent taxpayers before the IRS by virtue of his/her status as a law, business, or accounting
student working in an LITC or STCP. See instructions for Part II for additional information and requirements.
r Enrolled Retirement Plan Agent—enrolled as a retirement plan agent under the requirements of Circular 230 (the authority to practice before the
Internal Revenue Service is limited by section 10.3(e)).
SAMPLE
IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE
POWER OF ATTORNEY. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN PART I, LINE 2. See the instructions for
Part II.
▶
Note. For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column. See the instructions for Part II
for more information.
Designation—
Insert above
letter (a–r)
I
Licensing jurisdiction
(state) or other
licensing authority
(if applicable)
Bar, license, certification,
registration, or enrollment
number (if applicable).
See instructions for Part II for
more information.
Signature
Date
Czech Republic
Form 2848 (Rev. 7-2014)
Form
8822
Change of Address
(For Individual, Gift, Estate, or Generation-Skipping Transfer Tax Returns)
(Rev. October 2014)
Department of the Treasury
Internal Revenue Service
Part I
▶ Please
OMB No. 1545-1163
type or print. ▶ See instructions on back. ▶ Do not attach this form to your return.
▶ Information about Form 8822 is available at www.irs.gov/form8822.
Complete This Part To Change Your Home Mailing Address
Check all boxes this change affects:
1
Individual income tax returns (Forms 1040, 1040A, 1040EZ, 1040NR, etc.)
▶ If your last return was a joint return and you are now establishing a residence separate from the spouse with whom
▶
you filed that return, check here . . . . . . . . . . . . . . . . . . . . . . . . . . .
✔
2
Gift, estate, or generation-skipping transfer tax returns (Forms 706, 709, etc.)
▶ For Forms 706 and 706-NA, enter the decedent’s name and social security number below.
▶
Decedent’s name
▶
Social security number
3a
Your name (first name, initial, and last name)
3b
Your social security number
4a
Spouse’s name (first name, initial, and last name)
4b
Spouse’s social security number
5a
Your prior name(s). See instructions.
5b
Spouse's prior name(s). See instructions.
6a
Your old address (no., street, apt. no., city or town, state, and ZIP code). If a P.O. box, see instructions. If foreign address, also complete spaces below,
see instructions.
Foreign country name
6b
Foreign province/county
Spouse’s old address, if different from line 6a (no., street, apt. no., city or town, state, and ZIP code). If a P.O. box, see instructions. If foreign address, also
complete spaces below, see instructions.
Foreign province/county
Foreign country name
7
Foreign postal code
Foreign postal code
New address (no., street, apt. no., city or town, state, and ZIP code). If a P.O. box, see instructions. If foreign address, also complete spaces below, see
instructions.
DENDAX Jemnicka 1138/1, Praha 4
Foreign country name
Foreign province/county
Foreign postal code
Czech Republic
Part II
140 06
Signature
Daytime telephone number of person to contact (optional) ▶
Your signature
Date
If joint return, spouse’s signature
Date
For Privacy Act and Paperwork Reduction Act Notice, see back of form.
▲▲
▲▲
Sign
Here
Signature of representative, executor, administrator/if applicable
Date
Title
Cat. No. 12081V
Form
8822
(Rev. 10-2014)