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Section, Office of the Revenue Commissioners, Collector-General s Division, Nenagh, Co. Tipperary, Ireland. Tel: +353 67 63400 Fax: +353 67 44182 E-mail: intclaims revenue.ie Name of Claimant: Full Name: (CAPITAL LETTERS) Trading Name: Address: This space is for official use only Warrant No: Amount: Checked by: Approved by: Tel No: Date: Date: E-mail: 1 QUESTION Is this a joint account? If so, please see notes overleaf. 2 Please quote the Irish tax reference number. 3 ANSWER.

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