Form De1 - Application To Have Deposit Interest Paid Without Deduction Of Dirt Where Applicant And/or Spouse Or Civil Partner Is Aged 65 Or Over - 2017
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1
2Form DE1 2017
Application to have deposit interest paid without deduction of DIRT
where applicant and/or spouse or civil partner is aged 65 or over
Please read the explanatory notes overleaf before completing this form
Full Name of Applicant
PPS Number
Date of Birth
/
/
D D
M M
Y
Y
Y
Y
Address
Eircode
Spouse or Civil Partner Details
(where appropriate)
Full Name of Spouse
or Civil Partner
PPS Number
Date of Birth
/
/
D D
M M
Y
Y
Y
Y
Financial Institution
Name of Branch/Office
Address of Branch/Office
Eircode (if known)
Account Details
Financial Institution
Account/Membership (Credit Union) Number
Date Received Stamp
Name of Account Holder(s)
BIC
(Max. 11 characters)
IBAN
(Max. 34 characters)
Declaration
I (we) declare that I am (we are) beneficially entitled to the interest in respect of the account above and that:
I am (my spouse or civil partner is, or both of us are) aged 65 years or over in the year 2017
My (our) total annual income does not exceed the exemption limit for the year 2017 of
€18,000 for Single People or Widowed Persons or Surviving Civil Partners
€36,000 for Married Couples or Civil Partners (combined income)
These limits are increased if you have dependent children - see overleaf for full details
I (we) undertake to advise the Financial Institution of any change in circumstance that may affect my (our) eligibility
to have interest paid on my (our) account without deduction of DIRT
Signature of Applicant (Account Holder)
Signature of Spouse or Civil Partner
(Joint Account only)
Date
D D
/
M M
/
Y
Y
Y
Y
RPC008172_EN_WB_L_1
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