FORM P50
FIRST CLAIM FOR A REPAYMENT OF INCOME TAX AND/OR
UNIVERSAL SOCIAL CHARGE (USC) DURING UNEMPLOYMENT
Please read the INFORMATION NOTES overleaf BEFORE completing this form. N.B. Form P45 Parts 2 & 3 MUST accompany this claim.
Name and Address (include Eircode)
PPS Number
Employer Number
D D M M Y Y
Refer to your Form P45 for answers to above
Date of Cessation of Employment
ALL SECTIONS AND THE DECLARATION MUST BE COMPLETED
Details of income received by you since the date you became unemployed Insert T in appropriate box(es) below
Jobseeker’s Benefit
Other Income received from the Department of Social Protection
State payment type
Illness Benefit
In the case of the above, state the date this income started
D D M M Y Y
Number of children included in your claim
Gross weekly amount
€
Jobseeker’s Assistance (this is not a taxable source of income)
Other Income not subject to PAYE
Gross amount received to date
€
State the source of this income
Do you intend to resume employment in Ireland before 31 December next? Y/N
If the answer is “No”, state reason
If resuming education, state name
of school/college
Are you making this claim on the basis that you are going abroad? Y/N
If the answer is “Yes” state:
(a) country of destination
D D M M Y Y
(b) intended departure date
(c) duration of stay abroad
Do you intend to take up employment abroad? Y/N
Address abroad for correspondence
Refunds
If you wish to have any refund paid directly to your bank account, please provide your bank account details.
(Note: It is quicker to receive payments electronically than by cheque.)
Single Euro Payments Area (SEPA)
Account numbers and sort codes have been replaced by International Bank Account Numbers (IBAN) and Bank
Identifier Codes (BIC). These numbers are generally available on your bank account statements. Further information
on SEPA can be found on
It is not possible to make a refund directly to a foreign bank account that is not a member of SEPA.
International Bank Account Number (IBAN)
(Maximum 34 characters)
Bank Identifier Code (BIC)
(Maximum 11 characters)
Note: Any subsequent Revenue refunds will be made to this bank account unless otherwise notified.
I declare that I am unemployed and that all particulars given in this form are stated correctly
D D M M Y Y
Signature
Date:
Telephone or E-mail:
A person who knowingly makes a false statement for the purpose of obtaining repayment of income tax is liable to heavy penalties.
RPC007010_EN_WB_L_1
1
2
