Application for a (partial) exemption from, or refund of, Dutch dividend tax (universal)
You can read the PDF by using Adobe Reader. You can download this programme from Adobe. The Tax and Customs Administration is not responsible for the installation and use of the reader.
By using this form, residents of treaty countries other than the USA, Aruba, the Netherlands Antilles, Belgium, the United Kingdom of Great Britain and Northern Ireland, the Irish Republic, Israel, Japan, Malaysia, Malta and Singapore, may apply for a (partial) exemption from, or refund of, Dutch dividend tax.