Tax Return And Self Assessment For The Year 2015 Page 24
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36ANY PANEL(S) OR SECTION(S) THAT DO NOT REQUIRE AN ENTRY SHOULD BE LEFT BLANK.
2015120
PPS Number
525. Incapacitated Child Tax Credit
(a) To claim this tax credit state the number of incapacitated children
Date of Birth
PPS Number
/
/
(b) Date of Birth and PPS Number of each incapacitated child
/
/
/
/
(c) Amount of tax credit being claimed
.
00
,
(Note: to qualify for this credit you must hold a certificate from
a medical practitioner confirming that the child is permanently incapacitated)
526. Medical Insurance Premiums - Paid by your employer
Self
(a) If your Employer paid premiums on your behalf, to an authorised insurer, in 2015 state, in respect of each such premium:
(i)
(ii)
(iii)
(iv)
(v)
Name of person
Amount of the
If this
Amount of any
No. of months
covered by policy
Gross premium
individual
contribution towards
in 2015 where
attributable to
is a 'child'
this premium made
the policy was
this individual
insert T
by you to your
active
employer
.
.
00
00
,
,
.
.
00
00
,
,
.
.
00
00
,
,
Spouse or Civil Partner
(b) If your spouse's or civil partner's employer paid premiums on their behalf, to an authorised insurer, in 2015 state, in respect of each
such premium:
(i)
(ii)
(iii)
(iv)
(v)
Name of person
Amount of the
If this
Amount of any
No. of months
covered by policy
Gross premium
individual
contribution towards
in 2015 where
attributable to
is a 'child'
this premium made
the policy was
this individual
insert T
by you to your
active
employer
.
.
00
00
,
,
.
.
00
00
,
,
.
.
00
00
,
,
Spouse or
Self
Civil Partner
527. (a) Owner Occupier Relief on a Residential Property
in a Designated Area other than a claim in respect of
.
.
00
00
,
,
,
,
Living City Initiative - Amount due in 2015
(b) Living City Initiative
Where there is a claim for Owner Occupier Relief in respect of Living City Initiative (S. 372AAB) state:
.
.
00
00
(i) Amount due in 2015
,
,
,
,
(ii) The address of the qualifying premises in respect
of which the qualifying expenditure was incurred,
include Eircode (if known)
(iii) The unique Identification Number (if any) assigned
to the qualifying premises under S. 27 F(LPT) Act 2012
[Property Identification for LPT purposes]
(iv) Details of the aggregate of all qualifying expenditure
.
.
incurred by the individual in respect of the qualifying
00
00
,
,
,
,
premises
(v) Reference number supplied by the Local Authority
with the Letter of Certification
(vi) Market value of the property prior to
.
.
00
00
refurbishment/conversion
,
,
,
,
(c) Property based incentive scheme - Where you are claiming relief
at Line 527(a), insert T in the box and give details in Panel N on pages 30/31
PAGE 24
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