Form Med 2 - Dental Expenses - Certifed By Dental Practitioner
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1
2Form MED 2
Dental Expenses
Certified by Dental Practitioner
Name and Address
Note: This form is a receipt and should be retained by you as
evidence of expenses incurred. Claims for tax relief on any of
the expenses mentioned overleaf should be claimed either
through Revenue’s PAYE Anytime service on
or by completing and submitting Form MED1 to your Regional
Revenue office.
4-year time limit: A claim for tax relief must be made within four
PPS No.
years after the end of the tax year to which the claim relates.
Nature of treatment
Insert T in the
Date(s) on which
Date(s) on which
Amount
(see overleaf)
appropriate box
treatment was carried
payments were made
paid
out
€
A
B
C
D
E
F
G
H
I
J
I certify that all particulars given on this form are correct and that I have received the amounts shown above.
D D M M Y Y
Signature of Dental Practitioner
Date
Name and Address of Dental Practitioner
(use CAPITAL LETTERS)
Qualifications of Dental Practitioner
(use CAPITAL LETTERS)
PPS No. of Dental Practitioner
RPC002211_EN_WB_L_1
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