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formdr1

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									                  Claim for Dependent Relative Tax Credit
Claimant’s Details
Name

Address




PPS Number


Details of Relative in respect of whom tax credit is claimed
Name

Address




PPS Number

Relationship to you
Source(s) of income of relative
(e.g. old age pension, deposit interest, etc.)

Annual amount of his or her income                  €          ,          .0 0

Annual amount contributed by others                 €          ,          .0 0

If claim is not for a widowed father or mother of yourself, spouse
or civil partner or a parent of your civil partner who is himself or
herself a surviving civil partner state,
Dependent’s date of birth                               D D MM Y Y Y Y

Nature of the infirmity

RPC001732_EN_WB_L_1                                                Please See Over
4 - year time limit:
A claim to tax relief must be made within 4 years after the end of the tax
year to which the claim refers.

Refunds
Tax refunds can be paid by transfer to your Irish bank account. It is not
possible to make a refund directly to a foreign bank account.
If you wish to have any refund paid directly to your Irish bank account,
please supply your bank account details below.


Note:
Any subsequent Revenue refunds will be made to this bank
account until otherwise notified.

Sort Code

Account Number


                                Declaration

I declare that all the particulars given in this form are correct to the best
of my knowledge and belief.

Signature

Daytime Telephone Number

Email

Date                                                     D DMM Y Y Y Y




Form DR1

								
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