Tax Return And Self Assessment For The Year 2015 (Page 2 of 36) in pdf

ANY PANEL(S) OR SECTION(S) THAT DO NOT REQUIRE AN ENTRY SHOULD BE LEFT BLANK.

2015120

PPS Number

When completing this return you should read the appropriate Helpsheet. If you have not received a copy of the

Helpsheet you can get one from Revenue’s website (under 'Taxes & Duties > Income Tax > Forms >

Tax Return Forms'), or from Revenue’s Forms & Leaflets Service by phoning LoCall 1890 306 706 (ROI only),

+353 1 702 3050 (if calling from outside ROI). This return is only to be used for the 2015 tax year.

Legislative references relate to Sections of the Taxes Consolidation Act (TCA) 1997, unless otherwise stated.

The Revenue Commissioners will treat as confidential the information provided by you in this form. However, Revenue

may, when permitted or requested to do so by legislation, disclose this information to other Public Bodies. Further

details are available on

A - PERSONAL DETAILS

[1 - 21]

1. If you are completing this return on behalf of a deceased individual:

(Note: in the case of a married person or civil partner, only complete this section where the deceased

was the assessable spouse or nominated civil partner in the period to which this return refers.)

(a) Enter the date of death (DD/MM/YYYY)

(b) Enter the name of the personal representative

(i.e. executor, administrator, etc.)

2. Insert T in the box to indicate your civil status:

3. If your personal circumstances changed in 2015 insert T in the

box to indicate your previous status and state date of change:

Single

(a)

Single

Married

In a Civil Partnership

(b) Married

Widowed

Surviving Civil Partner

(d) Married but living apart

Married but living apart

In a Civil Partnership

If wholly or mainly maintaining your

but living apart

Spouse insert T in the box

(e) In a Civil Partnership but living apart

Divorced

Former Civil Partner

f wholly or mainly maintaining your

Civil Partner insert T in the box

Date of Marriage or Civil Partnership

(DD/MM/YYYY)

(f) Widowed

(g) A Surviving Civil Partner

Date of Separation or Divorce

(DD/MM/YYYY)

(h) Divorced

Spouse's or Civil Partner's

(i) A former Civil Partner

date of death (DD/MM/YYYY)

4. If married or in a civil partnership, insert T in the box to indicate basis of assessment applicable for 2015:

Joint Assessment

Separate Assessment

Single Treatment

5. State the number of Dependent Children

6. If you wish to claim Widowed Person or Surviving Civil Partner with Dependent Child Tax Credit

state date of death of your spouse or civil partner (DD/MM/YYYY)

7. Your date of birth (DD/MM/YYYY)

Spouse or

8. Insert T in the relevant box(es) to indicate for 2015 if you and/or your spouse

Self

Civil Partner

or civil partner are/is subject to the Limitation on the Use of Reliefs by High

Income Individuals (i.e. under Chapter 2A of Part 15 TCA 1997).

Yes

If either you or your spouse or civil partner is so subject, Form RR1 2015

should be completed and also Panel J on page 26

9. Spouse’s or Civil Partner's Details:

Surname

OR, if unknown

(a) PPS No.

(Pre-marriage or

pre-Civil Partnership)

First name(s)

(b) Date of birth

(DD/MM/YYYY)

PAGE 2

FOR OFFICE USE ONLY

Tax Return And Self Assessment For The Year 2015 Page 2

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