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PRSI Refund Application

CONTACT DETAILS
( * - mandatory fields )

Title

First Name *

Middle Name

Surname *

Postal Address *

Email address *

Phone number *

Line Type *

Country Code *

Area Code *

Phone number *

Please send confirmation via SMS to this number

Date of Birth *

DD/MM/YYYY

How did you hear about our service? *

What is the name of that person/organisation? *

I would like taxback.com to organise my
tax refund from the Irish Tax Authorities

EMPLOYMENT INFORMATION We can only organise your refund when you tell us:

Approximate date of arrival in Ireland *

DD/MM/YYYY

Approximate date of departure from Ireland *

DD/MM/YYYY

Which Tax Year are you applying for? *

How many employers did you have in this tax year? *

How much, approximately, did you earn during the tax year you are applying for? *

€

Have you applied for this refund before?

Did you have any period of unemployment in Ireland
during this tax year?


Did you receive unemployment benefit from the Irish government?


Are there any other earnings that you had in this tax year that you would like to declare?
Did you receive any benefits during this tax year? *


Date you started receiving the benefits: *	DD/MM/YYYY
Date you stopped receiving the benefits: *	DD/MM/YYYY
Weekly amount of the benefits: *	€


PPS Number (if known)


EMPLOYER 1

Company Name *
What is your Occupation?
Irish Town/City: *
Street name and address: *
Name of HR/Office manager who issued your salaries:
Fax or Telephone Number
Approximate date you began work *	DD/MM/YYYY
Approximate date you finished work *	DD/MM/YYYY
Do you have your P45 or P60? *	If yes, please fax, scan and email or post to taxback.com today
If no, would you like us to source replacements for you?
Did you pay tax?


EMPLOYER 2

Company Name *
What is your Occupation?
Irish Town/City: *
Street name and address: *
Name of HR/Office manager who issued your salaries:
Fax or Telephone Number
Approximate date you began work *	DD/MM/YYYY
Approximate date you finished work *	DD/MM/YYYY
Do you have your P45 or P60? *	If yes, please fax, scan and email or post to taxback.com today
If no, would you like us to source replacements for you?
Did you pay tax?


EMPLOYER 3

Company Name *
What is your Occupation?
Irish Town/City: *
Street name and address: *
Name of HR/Office manager who issued your salaries:
Fax or Telephone Number
Approximate date you began work *	DD/MM/YYYY
Approximate date you finished work *	DD/MM/YYYY
Do you have your P45 or P60? *	If yes, please fax, scan and email or post to taxback.com today
If no, would you like us to source replacements for you?
Did you pay tax?


EMPLOYER 4

Company Name *
What is your Occupation?
Irish Town/City: *
Street name and address: *
Name of HR/Office manager who issued your salaries:
Fax or Telephone Number
Approximate date you began work *	DD/MM/YYYY
Approximate date you finished work *	DD/MM/YYYY
Do you have your P45 or P60? *	If yes, please fax, scan and email or post to taxback.com today
If no, would you like us to source replacements for you?
Did you pay tax?


EMPLOYER 5

Company Name *
What is your Occupation?
Irish Town/City: *
Street name and address: *
Name of HR/Office manager who issued your salaries:
Fax or Telephone Number
Approximate date you began work *	DD/MM/YYYY
Approximate date you finished work *	DD/MM/YYYY
Do you have your P45 or P60? *	If yes, please fax, scan and email or post to taxback.com today
If no, would you like us to source replacements for you?
Did you pay tax?

Have you also worked in any of the following countries? to select multiple options, hold down the control key while selecting
Did you receive a tax refund?

YOUR FEEDBACK AND ADDITIONAL INFORMATION
Please enter any additional comments and information here:

Please read our terms and conditions and indicate that you accept them in order for your registration to proceed
Yes, I accept the Terms and Conditions *

DON'T FORGET-IMPORTANT!
Once you hit submit you will need to send us your P45 or P60 from each of your employers (if you have them)