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| Column A | Column B | Column C |
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| Box number | The non-Union scheme | The Union scheme |
| 1 | Individual VAT identification number allocated by the Member State of identification in accordance with Article 362 of Directive 2006/112/EC | Individual VAT identification number allocated by the Member State of identification in accordance with Article 369d of Directive 2006/112/EC, including the country code |
| 2 | The national tax number, if any | |
| 3 | The company name | The company name |
| 4 | The trading name(s) of the company if different from the company name | The trading name(s) of the company if different from the company name |
| 5 | The full postal address | The full postal address |
| 6 | The country in which the taxable person has his place of business | The country in which the taxable person has his place of business if not in the Union |
| 7 | The e-mail address of the taxable person | The e-mail address of the taxable person |
| 8 | The website(s) of the taxable person where available | The website(s) of the taxable person where available |
| 9 | Contact name | Contact name |
| 10 | Telephone number | Telephone number |
| 11 | IBAN or OBAN number | IBAN number |
| 12 | BIC number | BIC number |
| 13.1 | Individual VAT identification number(s) or if not available, tax reference number(s) allocated by the Member State(s) in which the taxable person has a fixed establishment(s) | |
| 14.1 | Full postal address(es) and trading name(s) of fixed establishments | |
| 15.1 | VAT identification number(s) allocated by Member State(s) as a non-established taxable person | |
| 16 | Electronic declaration that the taxable person is not registered for VAT within the Union | |
| 17 | Date of commencement of using the scheme | Date of commencement of using the scheme |
| 18 | Date of request to be registered under the scheme by the taxable person | Date of request to be registered under the scheme by the taxable person |
| 19 | Date of registration decision by the Member State of identification | Date of registration decision by the Member State of identification |
| 20 | Indicator of whether the taxable person is a VAT group | |
| 21 | Individual VAT identification number(s) allocated by the Member State of identification in accordance with Articles 362 or 369d of Directive 2006/112/EC if they have previously used either scheme | Individual VAT identification number(s) allocated by the Member State of identification in accordance with Articles 362 or 369d of Directive 2006/112/EC if they have previously used either scheme |
| Individual VAT identification number allocated by the Member State of identification, including country code | |
|---|---|
| Date from which the change is effective |
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| Part 1: General information | ||
|---|---|---|
| Column A | Column B | Column C |
| Box number | The non-Union scheme | The Union scheme |
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Unique reference number
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| 1 | Individual VAT identification number allocated by the Member State of identification, in accordance with Article 362 of Directive 2006/112/EC | Individual VAT identification number allocated by the Member State of identification, in accordance with Article 369d of Directive 2006/112/EC, including country code |
| 2 | VAT period | VAT period |
| 2a | Start date and end date of period | Start date and end date of period |
| 3 | Currency | Currency |
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Part 2:
For each Member State of consumption in which VAT is due
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| 2(a) Supplies carried out from the place of business or fixed establishment in the Member State of identification | ||
| 4.1 | Country code of the Member State of consumption | Country code of the Member State of consumption |
| 5.1 | Standard VAT rate in the Member State of consumption | Standard VAT rate in the Member State of consumption |
| 6.1 | Reduced VAT rate in the Member State of consumption | Reduced VAT rate in the Member State of consumption |
| 7.1 | Taxable amount at standard rate | Taxable amount at standard rate |
| 8.1 | VAT amount at standard rate | VAT amount at standard rate |
| 9.1 | Taxable amount at reduced rate | Taxable amount at reduced rate |
| 10.1 | VAT amount at reduced rate | VAT amount at reduced rate |
| 11.1 | Total VAT amount payable | Total VAT amount payable for supplies of services carried out from the place of business or fixed establishment in the Member State of identification |
| 2(b) Supplies carried out from fixed establishments not in Member State of identification
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| 12.1 | Country code of the Member State of consumption | |
| 13.1 | Standard VAT rate in the Member State of consumption | |
| 14.1 | Reduced VAT rate in the Member State of consumption | |
| 15.1 | Individual VAT identification number, or if not available tax reference number, allocated by the Member State of fixed establishment, including country code | |
| 16.1 | Taxable amount at the standard rate | |
| 17.1 | VAT amount payable at the standard rate | |
| 18.1 | Taxable amount at the reduced rate | |
| 19.1 | VAT amount payable at the reduced rate | |
| 20.1 | Total VAT amount payable for supplies of services carried out from fixed establishment not in Member State of identification. | |
| 2(c) Grand total for the place of business or fixed establishment in the Member State of identification, and all fixed establishments in all other Member States | ||
| 21.1 | Total VAT amount payable by all establishments (Box 11.1 + Box 11.2 … + Box 20.1 + Box 20.2 …) | |