A. Status
1. State marital status?
2. Are you an employee?
  a. Are you a proprietary director?
  b. Are you a controlling shareholder?
3. If married, do both spouses have income?
  a. If married, is your spouse employed?
4. Do you have a child in respect of whom you are in receipt of child benefit?
  a. Are you the principal carer for the child(ren)?
5. What is your age range?
  a. If married, what is your spouse's age range?

B. Income and Allowances
6. Your Income Employment or self-employment income.
7. Have you made a qualifying pension contribution?
  a. Age attained during 2021?
  b. How much did you pay?  
8. If married, your spouse's income
9. Do you employ a carer for an incapacitated person?
10. If Yes - how much do you pay?
11. Does your employer pay your health insurance subscriptions?
  a. If yes - enter amount paid by your employer.

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Note - All figures in Euros, all figures rounded up to nearest Euro.