Fillable FORM CA4: Ofce of the Revenue Commissioners, Capital (Irish Tax & Customs)

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FORM CA4: Ofce of the Revenue Commissioners, Capital (Irish Tax & Customs)

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FORM CA4
This form on completion should be returned to:
Ofce of the Revenue Commissioners, Capital Acquisitions Tax Unit.
Telephone: LoCall 1890 20 11 04
PLEASE READ THE INFORMATION BELOW BEFORE COMPLETING THIS FORM.
This form should be completed if you require a letter of clearance (Form IT8) in respect of
securities, monies in bank, post ofce, building society, etc., held in the Irish State in the joint
names of the deceased and another or others where the amount is
(i) in excess of €50,000 where the deceased died on or after 26th January, 2001
(ii) in excess of €6,348.69 where the deceased died before 26th January, 2001.
The deceased’s PPS number (formerly RSI number) must be provided in all cases. Lack of a PPS
number will result in the Form CA4 being returned to the applicant.
PPS numbers will also be required for all beneciaries (including those resident overseas) listed in
the Summary of Benets page 4.
Irish disponer/beneciary
PPS numbers will normally be available from any documentation received either from the
Inspector of Taxes (e.g. tax credit certication or notice of assessment) or from the Department of
Social and Family Affairs.
Clients requiring PPS numbers can call into their nearest Department of Social and Family Affairs,
local or branch ofce. They will be required to produce valid identity information, e.g. long birth
certicate and other supporting documentation.
Foreign disponer/beneciary
Where a PPS number is required for a deceased person who is overseas or for beneciaries
resident overseas, solicitors or executors should contact Client Identity Services in the Department
of Social and Family Affairs directly by
Phone: LoCall 1890 92 79 99/01 7043281 or
E-mail: cis@welfare.ie
Identity information will be required before numbers can be issued.
If you need help in completing this form please refer to Form CA25, (A Guide to completing the
Inland Revenue Afdavit). While the Guide is not specic to this form, it provides assistance on
issues such as joint property, aggregation, group thresholds, taxation of foreign property, etc. It is
available on Revenue’s website www.revenue.ie by clicking on publications/Leaets and Guides/
Capital Acquisitions Tax/CA25 - A guide to completing the inland Revenue Afdavit (Form CA24).
Edition 2010
1
Deceased’s name
Deceased’s PPS No.
Deceased’s address
Date of death
Domicile at death
Domicile of origin
Place an “x” in the appropriate box if the disponer was resident or ordinarily
resident in the State at the date of death?
Place an “x” in the appropriate box if deceased left a will? If yes, attach a copy
If a grant has issued - state date of grant and attach a copy
(In this case please only complete questions 1 and 6 of the following Questionnaire)
Yes No
Yes No
QUESTIONNAIRE
1. Assets held jointly of any property (e.g. lands, houses, business, monies in bank, securities,
etc.) in the joint names of the deceased and another (or others) at the date of death.
DESCRIPTION OF PROPERTY GROSS MARKET
VALUE AT DATE OF DEATH
State in relation to each item of joint property the following information:
(i) name(s) of the other joint holder(s)
(ii) relationship of joint holder(s) to the deceased
(iii) date(s) the property was put into joint names
(iv) *by whom and in what shares the property was provided
(v) *purpose of putting the property into joint names
€
€
€
€
€
2
(vi) *how and in what shares the income from the property was dealt with or enjoyed
(vii) *title under which the property passes (e.g. will, intestacy, survivorship)
*where the money or other property in joint names was provided by the deceased this may, depending on the
actual or legally presumed intention, have given rise to a resulting trust in the deceased’s favour.
2. Assets in deceased’s sole name
State particulars of all property (e.g. lands, houses, business, monies in bank, securities,
etc.) in the sole name of the deceased at the date of death.
DESCRIPTION OF PROPERTY GROSS MARKET
VALUE AT DATE OF DEATH
3. Proceeds of life insurance policies
State particulars of any monies that became payable on the deceased’s death under any
policy or superannuation scheme whether effected by the deceased or not.
NAME OF INSURANCE COMPANY/SCHEME POLICY NO. GROSS VALUE AT
DATE OF DEATH
Enter in the Summary of Benets, page 4 details of any beneciary taking a benet in excess of €20,000 from
the policy.
4. Place an “x” in the appropriate box if the deceased was at any time the owner of a limited
interest (e.g. an annuity, right of residence, or an interest for life or otherwise in houses,
lands, securities etc.)?
If yes, furnish a copy of the relevant instrument.
€
€
€
€
€
Yes No
3
€
€
€
€
€
5. SUMMARY OF BENEFITS
Details: Beneciary No. 1
Current Benets. Include all current benets exceeding €20,000
Name:
Address:
PPS No. of Beneciary:
Relationship to deceased:
Value of Benets:
€
€
Place an “x” in the appropriate box if the beneciary is Irish Resident or Ordinarily Resident in the State
Yes No
Prior Benets: Where the beneciary has received any prior Aggregable Benets under the same threshold
since 05/12/1991, state the amount received
Details: Beneciary No. 2
Current Benets. Include all current benets exceeding €20,000
Name:
Address:
PPS No. of Beneciary:
Relationship to deceased: Value of Benets:
€
€
Place an “x” in the appropriate box if the beneciary is Irish Resident or Ordinarily Resident in the State
Yes No
Prior Benets: Where the beneciary has received any prior Aggregable Benets under the same threshold
since 05/12/1991, state the amount received
Details: Beneciary No. 3
Current Benets. Include all current benets exceeding €20,000
Name:
Address:
PPS No. of Beneciary:
Relationship to deceased:
Value of Benets:
€
€
Place an “x” in the appropriate box if the beneciary is Irish Resident or Ordinarily Resident in the State
Yes No
Prior Benets: Where the beneciary has received any prior Aggregable Benets under the same threshold
since 05/12/1991, state the amount received
6. Contact Details
Address
Date
Phone No.
CapacitySignature
Name
(in block capitals)
(successor, trustee, etc.)
4
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FORM CA4: Ofce of the Revenue Commissioners, Capital (Irish Tax & Customs)

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Completed 29 July 2020

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