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Gov.uk/self-assessment-forms-and-helpsheets Residence status Please read the Residence remittance basis etc. notes before you fill in boxes 1 to 14. you were not resident in the UK for 2015 16 If put X in the box you meet the third automatic overseas test put X in the box you are eligible for overseas workday relief for 2015 16 put X in the box you were resident in the UK in any of the previous 3 tax years put X in the box your circumstances meet the criteria for split year treatment for 2015 16 put X in the box you had a home overseas in 2015 16 more than 1 case of split year treatment applies Number of days spent in the UK during 2015 16 Number of days in box 10 attributed to exceptional circumstances How many ties to the UK did you have in 2015 16 Number of days you worked for more than 3 hours in the UK in 2015 16 overseas in 2015 16 5 you have made an entry in box 2 and any of your foreign earnings are for an earlier year you have an entry in box 3 enter the date from which the UK part of the year begins or ends DD MM YYYY SA109 2016 Page RR 1 HMRC 12/15 Personal allowances for non-residents and dual residents you are entitled to claim personal allowances as a non-resident because of the terms of a Double Taxation Agreement put X in the box Enter the code s for the country or countries of which you are a national and/or resident read the notes non-resident on some other basis or as a dual resident remittance basis user under the terms of certain Double Taxation Agreements read the notes put X in the box Relief under Double Taxation Agreements between the UK and other countries amount claimed because of an agreement awarding residence to another country read Helpsheet 302 Residence in other countries other than the UK in which you were resident for tax purposes for 2015 16 read the notes you were also resident in either or both of the countries above for 2014 15 enter the appropriate code s read the notes Relief claimed because of other provisions of the relevant Double Taxation Agreements read Helpsheet 304 If you are claiming relief in box 21 or box 22 fill in the appropriate claim form in Helpsheet 302 or Helpsheet 304 and send this as well Amount of Double Taxation Agreement income for which partial relief is being claimed Domicile you have put X in box 23 and have a domicile of origin within the UK enter the date on which your domicile changed DD MM YYYY you were born in the UK but have never been domiciled here put X in the box you are domiciled outside the UK and it is relevant to your Income Tax or Capital Gains Tax liability for 2015-16 put X in the box. Please explain in Box 40 how your domicile is relevant to your Income Tax or Capital Gains Tax liability outside the UK enter the date that you first came to live in the UK 2015 16 is the first year you have told us that your domicile is outside the UK put X in the box Substantial changes were made to the remittance basis of taxation from 6 April 2008 with further changes introduced from 6 April 2012. You were not resident in the UK for 2015 16 If put X in the box you meet the third automatic overseas test put X in the box you are eligible for overseas workday relief for 2015 16 put X in the box you were resident in the UK in any of the previous 3 tax years put X in the box your circumstances meet the criteria for split year treatment for 2015 16 put X in the box you had a home overseas in 2015 16 more than 1 case of split year treatment applies Number of days spent in the UK during 2015 16 Number of days in box 10 attributed to exceptional circumstances How many ties to the UK did you have in 2015 16 Number of days you worked for more than 3 hours in the UK in 2015 16 overseas in 2015 16 5 you have made an entry in box 2 and any of your foreign earnings are for an earlier year you have an entry in box 3 enter the date from which the UK part of the year begins or ends DD MM YYYY SA109 2016 Page RR 1 HMRC 12/15 Personal allowances for non-residents and dual residents you are entitled to claim personal allowances as a non-resident because of the terms of a Double Taxation Agreement put X in the box Enter the code s for the country or countries of which you are a national and/or resident read the notes non-resident on some other basis or as a dual resident remittance basis user under the terms of certain Double Taxation Agreements read the notes put X in the box Relief under Double Taxation Agreements between the UK and other countries amount claimed because of an agreement awarding residence to another country read Helpsheet 302 Residence in other countries other than the UK in which you were resident for tax purposes for 2015 16 read the notes you were also resident in either or both of the countries above for 2014 15 enter the appropriate code s read the notes Relief claimed because of other provisions of the relevant Double Taxation Agreements read Helpsheet 304 If you are claiming relief in box 21 or box 22 fill in the appropriate claim form in Helpsheet 302 or Helpsheet 304 and send this as well Amount of Double Taxation Agreement income for which partial relief is being claimed Domicile you have put X in box 23 and have a domicile of origin within the UK enter the date on which your domicile changed DD MM YYYY you were born in the UK but have never been domiciled here put X in the box you are domiciled outside the UK and it is relevant to your Income Tax or Capital Gains Tax liability for 2015-16 put X in the box. Please explain in Box 40 how your domicile is relevant to your Income Tax or Capital Gains Tax liability outside the UK enter the date that you first came to live in the UK 2015 16 is the first year you have told us that your domicile is outside the UK put X in the box Substantial changes were made to the remittance basis of taxation from 6 April 2008 with further changes introduced from 6 April 2012. Please read the Residence remittance basis etc. notes before filling in this section. you are making a claim for the remittance basis Amount of capital gains you are nominating use the Any other information box 40 your unremitted income and capital gains for 2015 16 is less than 2 000 put X in the box Adjustment to payments on account for capital gains If you enter X in this box do not enter X in boxes 31 or 32. Residence remittance basis etc. Tax year 6 April 2015 to 5 April 2016 2015 16 Your name Your Unique Taxpayer Reference UTR To get notes and helpsheets that will help you fill in this form go to www. gov.uk/self-assessment-forms-and-helpsheets Residence status Please read the Residence remittance basis etc. notes before you fill in boxes 1 to 14. you were not resident in the UK for 2015 16 If put X in the box you meet the third automatic overseas test put X in the box you are eligible for overseas workday relief for 2015 16 put X in the box you were resident in the UK in any of the previous 3 tax years put X in the box your circumstances meet the criteria for split year treatment for 2015 16 put X in the box you had a home overseas in 2015 16 more than 1 case of split year treatment applies Number of days spent in the UK during 2015 16 Number of days in box 10 attributed to exceptional circumstances How many ties to the UK did you have in 2015 16 Number of days you worked for more than 3 hours in the UK in 2015 16 overseas in 2015 16 5 you have made an entry in box 2 and any of your foreign earnings are for an earlier year you have an entry in box 3 enter the date from which the UK part of the year begins or ends DD MM YYYY SA109 2016 Page RR 1 HMRC 12/15 Personal allowances for non-residents and dual residents you are entitled to claim personal allowances as a non-resident because of the terms of a Double Taxation Agreement put X in the box Enter the code s for the country or countries of which you are a national and/or resident read the notes non-resident on some other basis or as a dual resident remittance basis user under the terms of certain Double Taxation Agreements read the notes put X in the box Relief under Double Taxation Agreements between the UK and other countries amount claimed because of an agreement awarding residence to another country read Helpsheet 302 Residence in other countries other than the UK in which you were resident for tax purposes for 2015 16 read the notes you were also resident in either or both of the countries above for 2014 15 enter the appropriate code s read the notes Relief claimed because of other provisions of the relevant Double Taxation Agreements read Helpsheet 304 If you are claiming relief in box 21 or box 22 fill in the appropriate claim form in Helpsheet 302 or Helpsheet 304 and send this as well Amount of Double Taxation Agreement income for which partial relief is being claimed Domicile you have put X in box 23 and have a domicile of origin within the UK enter the date on which your domicile changed DD MM YYYY you were born in the UK but have never been domiciled here put X in the box you are domiciled outside the UK and it is relevant to your Income Tax or Capital Gains Tax liability for 2015-16 put X in the box.