Tax Return And Self Assessment For The Year 2015 Page 18
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36ANY PANEL(S) OR SECTION(S) THAT DO NOT REQUIRE AN ENTRY SHOULD BE LEFT BLANK.
2015120
Spouse or
PPS Number
Self
Civil Partner
320. Other Offshore Products (S. 896). Give the following details for each material interest acquired in 2015 in (i) other offshore
products (including foreign life assurance policies) outside the EU or EEA, or outside a Member State of the OECD with
which Ireland has a Double Taxation Agreement and in (ii) 'unregulated funds' (those not coming within S.747B(2A))
within the EU or EEA, or within any Member State of the OECD with which Ireland has a Double Taxation Agreement
(a) Name & address of offshore product(s)
/
/
/
/
(b) Date material interest was acquired (DD/MM/YYYY)
(c) Amount of payment made in acquiring the material
.
.
00
00
,
,
,
,
interest
(d) Name & address of intermediary (if any) through whom the
material interest was acquired, include Eircode (if known)
.
.
321. (a) Additional Double Taxation Relief due
,
,
,
,
(b) Indicate the income source on
Irish employment income subject
which foreign tax was deducted
to non-refundable foreign tax
Other
(c) If you have selected Other, state:
(i) the type of income
(ii) the country where the tax was withheld
F - INCOME FROM FEES, COVENANTS, DISTRIBUTIONS, etc.
[401 - 409]
.
.
00
00
401. (a) Amount of Income from Fees, Commissions, etc.
,
,
,
,
(b) Description of Income
402. Irish Untaxed Income
.
.
00
00
(a) Irish Government Stocks
,
,
,
,
.
.
(b) Irish Exchequer Bills
00
00
,
,
,
,
.
.
00
00
(c) Irish Credit Union Dividends
,
,
,
,
.
.
00
00
(d) Other Loans and Investments arising in the State
,
,
,
,
403. Irish Deposit Interest
(a) Gross Deposit Interest received on which
.
.
00
00
DIRT was deducted
,
,
,
,
(b) Gross Interest received from Special Share
.
.
Account(s)/Special Term Share Account(s)/Special
00
00
,
,
,
,
Savings Account(s) on which DIRT was deducted
(c) Gross interest received where DIRT was not
.
.
00
00
,
,
,
,
deducted by virtue of S. 256(1A) or S. 256(1B)
404. Irish Dividends
(a)(i) Gross amount of Dividends from Irish Resident
Companies (from which Dividend Withholding Tax
.
.
00
00
was deducted), other than dividends received from
,
,
,
,
a Real Estate Investment Trust (REIT)
.
.
00
00
(ii) Gross amount of dividends received from a REIT
,
,
,
,
(b)
Gross amount of Dividends from Irish Resident
.
.
Companies (from which Dividend Withholding Tax
00
00
,
,
,
,
was not deducted)
405. Settlement, Covenant, Estate Income, Maintenance Payments, etc.
(a) Gross amount received/receivable,
.
.
00
00
where tax was not deducted
,
,
,
,
(b) Gross amount received/receivable,
.
.
00
00
where tax was deducted
,
,
,
,
PAGE 18
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