Please scroll down to the bottom of this pdf to add your signature.

Details for  


Full Name 
Address: , ,  
Date of Birth (DD/MM/YYYY):
Email Address:
PPS Number:
Job Title:
Phone Number:
Marital Status:
Number of Children:

Client Agreement with Agent

I hereby confirm that:

  1. I have signed the Client Declaration Form to authorise to be my agent and to represent me in all submissions and correspondences, to prepare my tax return(s) and represent me before the Revenue and the Department of Social Protection for the current tax year and the four preceding tax years.
  2. I understand that all refunds and calculations are subject to agreement with the Irish Tax Authorities.
  3. I confirm that I have provided accurate information and completed all forms honestly and hold receipts and documentations on file to support allowable expenses included in my tax return(s).
  4. I authorise to receive and process any refunds due to me and remit the refund less their commission by bank transfer. I agree a commission rate of 10% + VAT of refunds received however, if no refund is due there is no charge. Should I avail of any additional services, I understand additional fees may apply.
  5. Where I receive the refund from any source other than, I agree to send the agreed commission to within a period of 3 days by way of electronic fund transfer (EFT) or bank draft. At the expiration of that period, any outstanding amount on the account will be subject to interest by virtue of the Statutory Interest on Late Payments (Commercial Transactions) Regulations 2002. tax agent confirm that:

  1. We will deal with all your tax documents in the most confidentially and efficient manner. Once we are registered as your agent, we will review and submit your tax returns to the Revenue Commissioners within 3 working days.
  2. The Revenue Commissioners will send both you as customer and us as your agent a copy of a tax statement when a tax refund review is complete. We will check this statement the day it arrives to ensure it is correct and contact you for payment details the same day. Payment will be made within 3 working days of receipt of your payment details.
  3. We will retain and protect your personal information as per the relevant data protection legislation and will continue to act as your tax agent until you notify us otherwise. Please review our Privacy Policy on our website for further information.

1. Authorisation to Act as Agent
Client Name    
Client Date of Birth
Client PPS Number

The details below will be blank if you have selected 'Single,' 'Separated,' 'Divorced,' or 'Widowed' in the Marital Status option.

Spouse Name
Spouse Date of Birth
Spouse PPS Number

I  confirm that (TAIN 73377L) with an address at, 88 Shanganagh Vale, Cabinteely, Dublin 18, D18 AD71, to act as my agent in dealing with all aspects of the filing of my Irish income tax return, including the submission of refund or credit claims, allowances or reliefs. I confirm that this authorisation will remain in force until Revenue is formally notified of its cessation by either myself or

2. Authorisation for Agent to Receive Refunds on Behalf of Client

I authorise the transfer of any refund or repayment of PAYE/Income Levy/Universal Social Charge due to me by the Revenue Commissioners by electronic funds transfer to the following bank account which is held by Bank: AIB Name of Account Holder: / BIC: AIBKIE2D / IBAN: IE09AIBK93339213732118

I understand that any refund made by the Revenue Commissioners to my agent,, on my behalf is refunded in a similar manner as if same were being refunded directly to me and that once the refund is transferred into the bank account nominated by me I have no further call upon the Revenue Commissioners in respect of same. I understand that is acting as my agent and is solely responsible to me in respect of any refund received by them on my behalf. I further understand that my agent, is an independent entity and that the Revenue Commissioners
make no endorsement of my agent or any such agency and cannot accept any responsibility whatsoever for problems encountered by me in dealing with them.

I understand and agree that will input its own bank account details on the Revenue record for the duration of this mandate and will remove these details on the cessation of the mandate. I confirm that I am aware of, and agree to, the payment of the fees charged by in respect of the services carried out on my behalf and that this fee will be deducted from any amount refunded by Revenue and that the balance of this amount will be paid to me.

3. Terms and Conditions of Authorisation

I understand that Tax law provides for both civil penalties and criminal sanctions for the failure to make a return, the making of a false return, facilitating the making of a false return, or claiming tax credits, allowances or reliefs which are not due.

I confirm that I will provide the necessary documentation to to support any refund, credit claims or claims for allowances and reliefs made to Revenue on my behalf by I confirm that I will provide details of all my sources of income to the I understand that is required to retain a copy of all documentation relating to any refund or credit or allowance or relief claimed by the agent on my behalf and that the agent will be required to produce same to Revenue upon request.

Leave this empty:

Signature arrow sign here

Signed by Elma O’Hanlon -
Signed On: May 23, 2024

Signature Certificate
Document name: Tax Rebate Application
lock iconUnique Document ID: 06f5127134037845ef4c126787a373ab0a6628b7
Timestamp Audit
April 2, 2024 11:28 am ISTTax Rebate Application Uploaded by Elma O’Hanlon - - IP