Form De1 - Application To Have Deposit Interest Paid Without Deduction Of Dirt - 2016

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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
Please read the explanatory notes overleaf before completing this form
Full Name of Applicant
/
/
PPS Number
Date of Birth
Address
Eircode
Spouse or Civil Partner Details
(where appropriate)
Full Name of Spouse
or Civil Partner
PPS Number
Date of Birth
/
/
Please complete a separate form for each account you and/or your Spouse or Civil Partner hold.*
Financial Institution
Name of Branch/Office
Address of Branch/Office
Eircode (if known)
Account Details *Account may be with your Bank, Building Society, Credit Union or Post Office Savings Bank.
Financial Institution
Account/Membership (Credit Union) Number
Date Received Stamp
Name of Account Holder(s)
Bank Identifier Code (BIC) (if applicable)
(Max. 11 characters)
International Bank Account Number (IBAN)
(Max. 34 characters)
Declaration
I/We declare that I/We am/are beneficially entitled to the interest in respect of the account above and that:
I and/or my Spouse or Civil Partner am/are aged 65 years or over during the year, and
My/Our total annual income does not exceed the exemption limit for the year 2016 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.
This is a form authorised by the Revenue Commissioners. It may be subject to inspection by Revenue. It is an
offence to make a false declaration.
Signature of Applicant (Account Holder)
Signature of Spouse or Civil Partner
(Joint Account only) (if applicable)
Date (DD/MM/YYYY)
/
/
RPC006820_EN_WB_L_1

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