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He Revenue Commissioners, Collector Generals Division, Nenagh, Co.Tipperary, Ireland. Tel: +353 67 63400 Fax: +353 67 44182 E-mail: intclaims revenue.ie Full Name: Trading Name: Address: Tel No: E-mail: This space is for official use only. Agent (if enquiries to be addressed to him/her) Warrant No: Name: Amount: Address: Checked by: Date: Tel No: Approved by: Date: E-mail: BANK ACCOUNT DETAILS FOR REPAYMENT OF NON-RESIDENT CLAIMS Name of Claimant/Company: Bank Account Name: IBA.

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