Declaration to be made by an Irish Personal Retirement Savings Account (PRSA) Administrator
for the purpose of Exemption from Dividend Withholding Tax (DWT)
(as provided for by Chapter 8A, Part 6 of the Taxes Consolidation Act, 1997 – “ the Act”)
Name of PRSA Administrator:
Address of PRSA Administrator:
Irish tax reference number of PRSA Administrator:
1. An “excluded person” may receive relevant distributions
from companies resident in Ireland without the deduction of
DWT where the excluded person is benecially entitled to the
relevant distributions and where a declaration has been made
to the “relevant person”. An “excluded person”, in relation to a
relevant distribution, has the meaning assigned to it by Section
172C(2) TCA 1997.
2. A “relevant person” is dened as:
a company resident in Ireland which makes a relevant
distribution directly to the person benecially entitled to the
a qualifying intermediary, where the relevant distribution has
been made indirectly to the person benecially entitled to
the distribution via that qualifying intermediary; in addition,
where relevant distributions are made via an authorised
withholding agent, that agent effectively steps into the shoes
of the company, and is the “relevant person” in relation to the
3. An exemption from DWT can only be obtained where
a completed declaration has been given to the “relevant
person”. If the declarant is dealing directly with the Irish paying
company, please forward this completed declaration to that
paying company. If the declarant is making this declaration via
a qualifying intermediary or an authorised withholding agent,
please return the completed declaration to that intermediary or
4. The Revenue Commissioners maintain a list of qualifying
intermediaries and authorised withholding agents. If you want
to nd out whether the intermediary you wish to use in relation
to relevant distributions has been authorised by the Revenue
Commissioners for the purposes of the Act, please click on the
following hyperlink:
To contact DWT Section:
Tel:- +353-67-63105
Authorised Signatory: (Declarant) Title: (Mr./Ms.etc.)
Print name of Signatory here:
Capacity in which declaration is made:
Date: ____ / ____ / ____
I declare that, at the time of making this declaration, the above-named Administrator is benecially entitled to the
relevant distributions in respect of which this declaration is made, and is a person referred to in Section 172C(2)
(bb) of the Act, thereby being an “excluded person” for the purposes of Chapter 8A of Part 6 of the Act.
I further declare that, at the time of making this declaration, the relevant distributions in respect of which this
declaration is made will be applied as income of the PRSA (as dened by Section 787A of the Act).
I undertake that, in the event that the above-named Administrator ceases to be an “excluded person”, I will, by
written notice, bring that fact to the attention of the “relevant person” in relation to the relevant distributions.
Important: This declaration must be signed by the PRSA Administrator (as dened by Section 787A of the
Act) or by a person who holds power of attorney from the PRSA Administrator. Where
appropriate, a copy of the power of attorney should be furnished in support of this declaration.
The information in this document is provided as a guide only and is not professional advice, including legal advice. It should not
be assumed that the guidance is comprehensive or that it provides a denitive answer in every case.
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