I understand that Tax law provides for both civil penalties and criminal sanctions for the failure to make a return, the making of a false return, facilitating the making of a false return, or claiming tax credits, allowances or reliefs which are not due. I confirm that I am aware of, and agree to, the payment of the fees charged by Irish Tax Rebates in respect of the services carried out on my behalf and that this fee will be deducted from any amount refunded by Revenue and that the balance of this amount will be paid to me. I understand and agree that Irish Tax Rebates will input its own bank account details on the Revenue record for the duration of this mandate and will remove these details on the cessation of the mandate. I further understand that my agent Irish Tax Rebates is an independent entity and that the Revenue Commissioners make no endorsement of my agent or any such agency and cannot accept any responsibility whatsoever for problems encountered by me in dealing with them. I understand that Irish Tax Rebates is acting as my agent and is solely responsible to me in respect of any refund received by them on my behalf. I understand that any refund made by the Revenue Commissioners to my agent, Irish Tax Rebates, on my behalf is refunded in a similar manner as if same were being refunded directly to me and that once the refund is transferred into the bank account nominated by me I have no further call upon the Revenue Commissioners in respect of same. Name of Account Holder: Irish Tax Rebates

I authorise the transfer of any refund or repayment of PAYE/Income Levy/Universal Social Charge due to me by the Revenue Commissioners by electronic funds transfer to the following bank account which is held by Irish Tax Rebates: Authorisation for Agent to receive refunds on behalf of client

I confirm that this authorisation will remain in force until Revenue is formally notified of its cessation by either myself or Irish Tax Rebates, or for a maximum period of 4 years.Ģ. I confirm that all documentary evidence of entitlement to credits/reliefs claimed and taxable income sources, will be held for a period of 6 years, beginning at the end of the year of assessment to which the Return of Income and/or claim relates, by myself. To act as my agent in dealing with all aspects of the filing of my Irish income tax return, including the submission of refund or credit claims, allowances or reliefs. I, the undersigned, declare to the Revenue Commissioners of Ireland, that I authorise

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