1. Authorisation to Act as Agent

I, the undersigned, declare to the Revenue, authorise GOLDMANPEAKS, TAIN No: 72222A, Agent’s address: 83 Castlecurragh Heath, Mulhuddart, Dublin 15, to act as my agent in dealing with all aspects of Income Tax (IT), Corporation Tax (CT), Value Added Tax (VAT), Employer’s PAYE/PRSI (Financial &Payroll), Relevant Contract Tax (RCT), Environmental Levy (E Levy), the filing of my Irish income tax return, including the submission of refund or credit claims, allowances or reliefs.

I confirm that all documentary evidence of entitlement to credits/reliefs claimed and taxable income sources, will be held for a period of 6 years beginning at the end of the year of assessment to which the Return of Income and claim relates to myself.

I confirm that this authorisation will remain in force until Revenue is formally notified of its cessation by either myself or GOLDMANPEAKS.

I authorise the transfer of any refund or repayment of Income Tax (IT), Corporation Tax (CT), Value Added Tax (VAT), Employer’s PAYE/PRSI (Financial &Payroll), Relevant Contract Tax (RCT), Environmental Levy (E Levy) and due to me by the Revenue Commissioners by electronic funds transfer to the following bank account which is held by GOLDMANPEAKS.

Note: It is not possible to make a refund directly to a foreign bank account that is not a member of the Single Euro Payments Area (SEPA)

International Bank Account Number (IBAN) (Maximum 34 characters)

                IE84AIBK93228008598151

Bank Identifier Code (BIC) (Maximum 11 characters)

                AIBKIE2D

Name of Account Holder

                GOLDMANPEAKS

I understand that any refund made by the Revenue Commissioners to my agent, GOLDMANPEAKS, 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 GOLDMANPEAKS 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 GOLDMANPEAKS 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 GOLDMANPEAKS 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 GOLDMANPEAKS 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.

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 GOLDMANPEAKS to support any refund, credit claims or claims for allowance and reliefs made to Revenue on my behalf by GOLDMANPEAKS.

I confirm that I will provide details of all my sources of income to GOLDMANPEAKS.

I understand that the person  selected in Section 1 above is required to retain all documentation relating to any refund or credit or allowance or relief claimed by the agent on my behalf for a period of 6 years beginning at the end of the year of assessment to which the Return of Income and/or claim relates and that will be required to produce same to Revenue upon request.