Tax Credits Due Diligence Questionnaire

Company Name

Industry

Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Contact Person's Name

First NameLast Name

Contact Person's Title

Contact Person's Email

example@example.com

Contact Person's Phone

Please enter a valid phone number.

Type of Business Entity

Date of Incorporation/Formation

Date

Has the company claimed tax credits before?

YesNo

If yes, please specify the types of tax credits claimed

Is the company eligible for tax credits?

YesNoNot Sure

Please provide any documentation or evidence to support the tax credit claims.

Receipts Invoices Payroll Records

Please describe the company's activities that may qualify for tax credits

Additional Comments

By signing and submitting this questionnaire, I certify that the information provided is accurate and complete to the best of my knowledge. I authorize the company to verify the details and process the tax credits accordingly.

Date

Signature

Tax Credits Due Diligence Questionnaire

Company Information

Tax Credit Information

Documentation and Evidence

Certification and Authorization