Regulation 4 Interpretation
A notice of entitlement to relief at source given by an individual shall provide the information specified in paragraph (2) and a certificate and a declaration and undertaking in the terms specified in paragraphs (3) and (4) respectively.
The information specified in this paragraph is—
the full name and permanent address of the individual,
his national insurance number,
where he knows it, his tax office reference,
if he has neither a national insurance number nor a tax office reference but has a national pension number, that number, and
where he is not the insured under the contract, the full name and permanent address of every person insured under it.
The certificate specified in this paragraph is a certificate by the individual that the contract satisfies the requirement of subsection (2) of section 54 as to the person or persons insured.
The declaration and undertaking specified in this paragraph is a declaration and undertaking by the individual that—
to the best of his knowledge and belief all information provided in the notice is true,
he is resident in the United Kingdom at the date of making the claim, or is at that date performing duties which are treated by virtue of section 132(4)(a) of the Taxes Act as performed in the United Kingdom,
no payment made by him under the contract has been or will be made out of resources provided by another person for the purpose of enabling it to be made, and
he is not entitled to claim any relief or deduction in respect of any such payment under any other provision of the Tax Acts.