Tax Return And Self Assessment For The Year 2015 Page 36

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Name
PPS Number
PAY AND FILE
31 OCTOBER 2016
IMPORTANT
Please read the information below and overleaf before completing the Statement of Net Liabilities
In accordance with the Taxes Consolidation Act 1997, you are obliged to submit the following return and payment on or before
31 October 2016:
Preliminary Tax for the year of assessment 2016 including Universal Social Charge contributions
Payment of any balance of Income Tax due for the year of assessment 2015
Return of Income and Capital Gains for the year of assessment 2015
How to complete the payslip
You can ensure that your Income Tax payments are promptly and properly processed by completing the payslip below and forwarding it to
the Collector-General, PO Box 354, Limerick. You must complete the Statement of Net Liabilities whether you are making your payment
by Revenue On-Line Service Debit Instruction, Credit Card, Debit Card, Direct Debit or Single Debit Authority (see overleaf for details on
how to make a payment).
Please enter an amount in the relevant space on the Statement of Net Liabilities for the following:
1. Preliminary Tax 2016
The minimum Preliminary Tax payment you are obliged to make is an amount equal to the lesser of 90% of your final Income Tax liability
for 2016 or 100% of your final liability for 2015. If you are paying your 2016 Preliminary Tax by monthly Direct Debit, leave this box blank.
2. Balancing Amount 2015
Insert any outstanding balance of Income Tax for the year of assessment 2015. Tax already paid for this year should be taken into
consideration when calculating the amount of the balance outstanding.
If you have calculated that there is a credit due to you for this year, enter the amount and tick the box (x) to indicate that the value is a credit.
The credit will be automatically offset against any liabilities for other years on the Statement of Net Liabilities.
3. TOTAL NET AMOUNT
The Total Net Amount figure should match the sum total of declarations that you are making for the above periods.
If you have calculated that you have no Preliminary Tax 2016 or Balancing Amount 2015, enter a single ‘0’ in the appropriate box for that
category on the Statement of Net Liabilities.
IMPORTANT NOTE:
If you file this return on time, but at the date of filing, you have failed to submit your Local Property Tax (LPT) return or have failed to either
pay the LPT due or enter into an agreed payment arrangement, a surcharge should be added to the final liability. Therefore, the amount
payable in your Self-Assessment should be increased by 10%. Where the LPT is subsequently brought up to date, the amount of the
surcharge will be capped at the amount of the LPT liability involved. For assistance, you may wish to call the LPT Branch on
1890 20 02 55 (ROI only) or +353 1 702 3049 (outside ROI).
€ Payslip
Form 11
0000000AB
A.N. OTHER
PPS No.:
12-09-2016
Signature:
Date:
€ Statement of Net Liabilities
Name:
A. N. OTHER
Whole Euro only - DO NOT ENTER CENT
Income Tax
Preliminary Tax 2016
Single Debit Authority
00
1
2 2 2 2 2 2 2 2
X
.
,
,
Please debit my account no earlier than 31 October 2016
Place X in the
with the single amount specified.
box above if
DEBIT AMOUNT
Income Tax
Income Tax
Balancing Amount 2015
2015 is a
00
3 3 3 3 3 3 3 3
.
00
credit
2
.
4 4 4 4 4 4 4 4
,
,
,
,
International Bank Account Number (IBAN)
F O R
I B A N
S E E
Y O U R
B A N K
S T A T E M E N T
Bank Identifier Code (BIC)
P&F
TOTAL NET AMOUNT
00
.
E
A N D
B I C
6 6 6 6 6 6 6 6
1 + 2 ABOVE
,
,

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