Fillable Form CA24: INLAND REVENUE AFFIDAVIT (Irish Tax & Customs)

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Form CA24: INLAND REVENUE AFFIDAVIT (Irish Tax & Customs)

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The Form CA24: INLAND REVENUE AFFIDAVIT (Irish Tax & Customs) form is 32 pages long and contains:

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  • 773 other fields

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If the deceased was resident or ordinarily resident in the State at the date of death place in the appropriate box
Place in the appropriate box
to indicate relatives surviving
Children Parent(s) Grandparent(s) Remoter Relative
Part 1 Information relating to the deceased
Page 1
Details of Person/Solicitor to be contacted in the event of enquiry regarding this Affidavit
INLAND REVENUE AFFIDAVIT (Form CA24)
Ca
p
ital Ac
q
uisitions Tax Consolidation Act
,
2003
(
to be used where the deceased died on or after 5th December, 2001
)
DD MM YYYY
Forename of
deceased
A
ddress
PPS No. of
deceased
Surname of
deceased
Date of
death
The High Court (PROBATE)
5. Date of birth
(if known)
/ /
DD MM YYYY
Yes No
1.
2.
3.
4.
10.
12.
Place of
death
6.
Form CA24
Domicile at death (Country/State)8.
Domicile of origin (Country/State)
9.
Occupation
7.
A
ddress
Contact e-mail
Firm
Name
/ /
Telephone No.
DX Number (if applicable)
-
TAIN
A
gent's
Reference
(No. of)
Probate Office/Registry
Official Stamp
Place ⌧ in the appropriate box
to indicate status
11.
Married Single Divorced Widowed Legally separated
Civil partner
Surviving civil partner Former civil partner
All Probate related queries should be addressed
to the Probate Office/District Probate Registries.
Details available on www.courts.ie.
A
ll tax related queries should be addressed to the
Office of the Revenue Commissioners.
Contact details are available on www.revenue.ie
None
4951100594
A
guide (CA25) to completing this form is available on www.revenue.ie
This version of the form must be completed using a computer.
When completed, this form in duplicate
together with all other necessary
documentation for a Grant of Representation should be submitted to the Probate
Office/District Probate Registry
All fields are mandatory
Reset Form
Page 2
Part 2 Details of the applicants
Form CA24
Relationshi
p
to deceased
Forename of 2nd
A
pplicant
Surname of 2nd
App
licant
A
ddress
Occupation
Forename of 4th
A
pplicant
Surname of 4th
App
licant
A
ddress
Occupation
Occupation
Forename of 3rd
A
pplicant
Surname of 3rd
App
licant
A
ddress
Relationshi
p
to deceased
Relationshi
p
to deceased
In Part 2 all fields for each applicant must be completed
Relationshi
p
to deceased
Forename of 1st
A
pplicant
Surname of 1st
App
licant
A
ddress
Occupation
I/We, the Applicant(s)
4745100595
Page 3
Form CA24
Place in the appropriate box
make oath and say as follows:-
I/We have fully and correctly completed this form and given all the particulars requested therein. The information given is true to the best of my/our
knowledge and belief, and no property has been omitted because of uncertainty as to its amount, value etc. I/We undertake to furnish a Corrective
A
ffidavit (CA26) if at any time it shall appear that a material error or omission has been made.
Part 3 Sworn declaration
SWORN by
Probate of the deceased's will
A
dministration intestate of the
deceased's estate
A
dministration with will annexed of
the deceased's estate
Nominal Grant
(State Reason for
same)
I/We desire to obtain a grant of1.
2.
Forename of 1st Applicant
Surname of 1st Applicant
WARNING: IF THE APPLICANT(S) SWEAR TO THIS AFFIDAVIT WITHOUT PERSONALLY VERIFYING THAT THE STATEMENTS IN IT ARE
TRUE, THEY MAY MAKE THEMSELVES LIABLE TO PENALTIES.
Forename of 2nd Applicant
Surname of 2nd Applicant
A
t
On the day of
Before me, a Commissioner for Oaths/Practising Solicitor/Court Clerk
and
(Tick relevant box and Delete as appropriate)
(i) the Deponent (Applicant) is personally known to me
(ii) the Deponent (Applicant) has been identified to me by
who is personally known to me
Document Type: Issue No:
Signature Commissioner for Oaths/Practising Solicitor/Court Clerk
or
(iii) the identity of the Deponent has been established by reference to a relevant document containing a photograph
or
Identifier's Signature
I certify that I know the Deponent/Applicant
A
t
On the day of
Before me, a Commissioner for Oaths/Practising Solicitor/Court Clerk
and
(Tick relevant box and Delete as appropriate)
(i) the Deponent (Applicant) is personally known to me
(ii) the Deponent (Applicant) has been identified to me by
who is personally known to me
Document Type: Issue No:
Signature Commissioner for Oaths/Practising Solicitor/Court Clerk
(iii) the identity of the Deponent has been established by reference to a relevant document containing a photograph
or
Identifier's Signature
I certify that I know the Deponent/Applicant
Signature of Applicant/Deponent
Signature of Applicant/Deponent
or
3785100598
Forename of 3rd Applicant
Surname of 3rd Applicant
Forename of 4th Applicant
Surname of 4th Applicant
Part 3 Sworn declaration (cont.)
Page 4
Form CA24
A
t
On the day of
Before me, a Commissioner for Oaths/Practising Solicitor/Court Clerk
and
(Tick relevant box and Delete as appropriate)
(i) the Deponent (Applicant) is personally known to me
(ii) the Deponent (Applicant) has been identified to me by
who is personally known to me
Document Type: Issue No:
Signature Commissioner for Oaths/Practising Solicitor/Court Clerk
or
(iii) the identity of the Deponent has been established by reference to a relevant document containing a photograph
or
Identifier's Signature
I certify that I know the Deponent/Applicant
A
t
On the day of
Before me, a Commissioner for Oaths/Practising Solicitor/Court Clerk
and
(Tick relevant box and Delete as appropriate)
(i) the Deponent (Applicant) is personally known to me
(ii) the Deponent (Applicant) has been identified to me by
who is personally known to me
Document Type: Issue No:
Signature Commissioner for Oaths/Practising Solicitor/Court Clerk
or
(iii) the identity of the Deponent has been established by reference to a relevant document containing a photograph
or
Identifier's Signature
I certify that I know the Deponent/Applicant
WARNING: IF THE APPLICANT(S) SWEAR TO THIS AFFIDAVIT WITHOUT PERSONALLY VERIFYING THAT THE STATEMENTS IN IT ARE
TRUE, THEY MAY MAKE THEMSELVES LIABLE TO PENALTIES.
Signature of Applicant/Deponent
Signature of Applicant/Deponent
7859100594
COPY OF THE WILL/CODICIL (IF ANY) MUST BE ATTACHED TO THIS FORM
Part 4 Propert
y
in the State passin
g
under the Will/Intestac
y
of the deceased
(include also any property under Part IX or Section 56 of the Succession Act, 1965, or under any analogous law)
Use continuation sheet on page 8 where necessary
Gross market value
at date of death
Gross market value at the date of death of real and leasehold property (houses, apartments,
lands, etc.). (Please refer to CA25 for guidance on completion of this question).
Page 5
Business assets not included elsewhere in this Part
(a) Farming assets (livestock, bloodstock, farm implements, machinery etc.)
Enter details below. Where insufficient space please complete page 8
(b) Other business assets (goodwill, plant and equipment, stock-in-trade, book debts etc.)
Enter details below. Where insufficient space please complete page 8.
A
ll considerations to be stated in whole EURO only. Do not enter Cent
Form CA24
Cars/boats. Enter details below. Where insufficient space please complete page 8.
Household contents (furniture, antiques, jewellery, paintings etc.)
Enter details below. Where insufficient space please complete page 8.
Carried forward
Questions 1 - 4
Total
1.
2.
3.
4.
, ,
Millions Thousands Hundreds
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
Total
Registration No. Make Model
Details of Household Contents
9043100591
Page 6
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Brought forward
Assets with financial institutions (eg. banks, building societies, insurance
companies, post office, credit unions, etc.) - property disclosed in Part 6 which passes
beneficially by survivorship or nomination should not be included in this Part.
Enter details below. Where insufficient space please complete page 8.
Proceeds of life insurance policies - policies disclosed in Part 6 which were written on trust
with named beneficiaries should not be included in this Part.
Enter details below. Where insufficient space please complete page 8.
Stocks, Shares and Securities
Quoted (if the deceased held a portfolio of shares attach statement from relevant agent/broker)
Description (including unit of quotation, size of holding and quoted price per unit)
Enter details below. Where insufficient space please complete page 8.
Carried forward
Questions 1 - 8
Debts owing to the deceased - Enter details below. Where insufficient space please complete
page 8.
Name of institution
Policy no.
Quoted price
per unit
Size of
holding
Description of holding
5.
6.
7.
8.
Name and address of debtor
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
Gross market value
at date of death
, ,
Millions Thousands Hundreds
Name and branch of institution
A
ccount no./reference no.
4524100590
Page 7
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Irish debts owing by the deceased and funeral expenses payable in the State
Gross market value
at date of death
Brought forward
Total Irish Debts (B)
Total Net Irish Estate (A-B)
Unpaid purchase money of property contracted to be sold in the deceased's lifetime
Total Gross Irish Estate (A)
Dividends accruing to the estate
Description (including type and class of share/security)
Enter details below. Where insufficient s
p
ace
p
lease com
p
lete
p
a
g
e 8
Total of any other property not already included. Please list separately on page 8
9.
10.
11.
Credito
r
Description of debt
Funeral expenses
Wake expenses
Headstone
Utilities (total amount)
A
mounts due to financial
institutions
Description of holding
Type of
holding
Class of share
/security
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
Millions Thousands Hundreds
, ,
Debts owing to persons resident in the State, or to persons resident outside the State, but
contracted to be paid in the State, or charged on property situate within the State.
*
*
0072100594
Page 8
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Description of all other property not already included
Gross market value
at date of death
Millions Thousands Hundreds
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
Total carried back to page 7
Question 10
If insufficient space, attach a schedule and enter amount per schedule
3183100590
Page 9
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Part 5 Property outside the State passing under the Will/Intestacy of the deceased
(include also any property passing under Part IX or Section 56 of the Succession Act, 1965, or under any analogous law)
1. Description and local situation of the property
Gross market value
at date of death
Total Gross Foreign Estate (C)
2. Foreign debts owing by the deceased and funeral expenses payable outside the State
Debts owing to persons resident outside the State, other than debts contracted to be paid in the
State, or charged on property situate within the State which have been deducted in Part 4.
Total Net Foreign Estate (C-D)
Total Debts (D)
3. Where the net US property exceeds €20,000 enter the net value of that property
4. Where the net UK property exceeds €63,500 enter the net value of that property
Creditor Description of debt
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
, ,
Millions Thousands Hundreds
, ,
*
*
Description Location
2708100592
Page 10
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Note: Questions 1 - 12 in this Part must be answered in all cases. Place in the
a
pp
ro
p
riate box and
g
ive an
y
additional information re
q
uired
PART 5 - CONTINUED
If Yes, provide in relation to each such item the following information:
Part 6 Questionnaire
Y
es No1.
Was there any Irish and/or foreign property (e.g. lands, house, business, monies in bank, securities
etc.) held jointly (as a joint tenant or as a tenant in common) by the deceased and another (or others)
at the date of death?
(a) full particulars of the next property
(a)
(c)
Will Intestacy Survivorship
(e)
(b)
, ,
Convenience Survivorship
/ /
DD MM YYYY
Forename
Surname
Forename
Surname
(f)
(g)
(h)
(i)
Where 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.
Millions Thousands Hundreds
*
*
*
*
(d) relationship
to deceased
(d) relationship
to deceased
by whom and in what shares the property was provided
purpose of putting the property into joint names
how and in what shares the income from the property was dealt with or enjoyed
title under which the property passes
*
date the property was put into joint names
its total value
name(s) of the other joint holder(s)
full particulars of 1st property
(c)
Will Intestacy Survivorship
(e)
(b)
, ,
Convenience Survivorship
/ /
DD MM YYYY
Forename
Surname
Forename
Surname
(f)
(g)
(h)
(i)
Where 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.
Millions Thousands Hundreds
*
*
*
*
(d) relationship
to deceased
(d) relationship
to deceased
by whom and in what shares the property was provided
purpose of putting the property into joint names
how and in what shares the income from the property was dealt with or enjoyed
title under which the property passes
*
date the property was put into joint names
its total value
name(s) of the other joint holder(s)
Joint
Tenant
Please indicate if you are a Joint Tenant or Tenant in Common
Tenant
in Common
Please indicate if you are a Joint Tenant or Tenant in Common
Joint
Tenant
Tenant
in Common
0183100597
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Page 11
(a) full particulars of the next property
(c)
Will Intestacy Survivorship
(e)
(b)
, ,
Convenience Survivorship
/ /
DD MM YYYY
Forename
Surname
Forename
Surname
(f)
(g)
(h)
(i)
Where 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.
Millions Thousands Hundreds
*
*
*
*
(d) relationship
to deceased
(d) relationship
to deceased
by whom and in what shares the property was provided
purpose of putting the property into joint names
how and in what shares the income from the property was dealt with or enjoyed
title under which the property passes
*
date the property was put into joint names
its total value
name(s) of the other joint holder(s)
(a) full particulars of the next property
(c)
Will Intestacy Survivorship
(e)
(b)
, ,
Convenience Survivorship
/ /
DD MM YYYY
Forename
Surname
Forename
Surname
(f)
(g)
(h)
(i)
Where 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.
Millions Thousands Hundreds
*
*
*
*
(d) relationship
to deceased
(d) relationship
to deceased
by whom and in what shares the property was provided
purpose of putting the property into joint names
how and in what shares the income from the property was dealt with or enjoyed
title under which the property passes
*
date the property was put into joint names
its total value
name(s) of the other joint holder(s)
Joint
Tenant
Please indicate if you are a Joint Tenant or Tenant in Common
Tenant
in Common
Joint
Tenant
Please indicate if you are a Joint Tenant or Tenant in Common
Tenant
in Common
4288100597
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Page 12
Form CA24
(a) full particulars of the next property
(c)
Will Intestacy Survivorship
(e)
(b)
, ,
Convenience Survivorship
/ /
DD MM YYYY
Forename
Surname
Forename
Surname
(f)
(g)
(h)
(i)
Where 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.
Millions Thousands Hundreds
*
*
*
*
(d) relationship
to deceased
(d) relationship
to deceased
by whom and in what shares the property was provided
purpose of putting the property into joint names
how and in what shares the income from the property was dealt with or enjoyed
title under which the property passes
*
date the property was put into joint names
its total value
name(s) of the other joint holder(s)
(a) full particulars of the next property
(c)
Will Intestacy Survivorship
(e)
(b)
, ,
Convenience Survivorship
/ /
DD MM YYYY
Forename
Surname
Forename
Surname
(f)
(g)
(h)
(i)
Where 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.
Millions Thousands Hundreds
*
*
*
*
(d) relationship
to deceased
(d) relationship
to deceased
by whom and in what shares the property was provided
purpose of putting the property into joint names
how and in what shares the income from the property was dealt with or enjoyed
title under which the property passes
*
date the property was put into joint names
its total value
name(s) of the other joint holder(s)
Joint
Tenant
Please indicate if you are a Joint Tenant or Tenant in Common
Tenant
in Common
Joint
Tenant
Please indicate if you are a Joint Tenant or Tenant in Common
Tenant
in Common
9661100597
Page 13
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Did any monies, (capital sum, annuity etc.) other than those (if any) included in Part 4 or 5,
become payable on or by reference to the death of the deceased under the provisions of any
superannuation scheme (whether ex-gratia or not), policy of insurance etc?
Other relevant particulars (e.g. Amount and term of annuities)
Did any person benefit on the death of the deceased under a nomination at any time made
by the deceased? (Credit Union Account, etc.)
Place in the appropriate box
2.
3.
Description of holding
Name of beneficiary
Y
es No
, ,
, ,
, ,
Millions Thousands Hundreds
, ,
, ,
, ,
, ,
, ,
, ,
If Yes, state
(
indicatin
g
with an asterisk an
y
ex-
g
ratia amount
)
:
*
A
mount
(a) Was the deceased in receipt of any Social Welfare payments?
If Yes, state the claim no.
(b) Has the Department of Social Protection any claim against the estate of the deceased?
(a) Was the deceased survived by a spouse or civil partner?
(a) Was the deceased in receipt of payments under the Nursing Home Support Scheme?
(b) If so state the position as to election under Section 115 of the Succession Act, 1965
Elect Not Elect
(b) If Yes, has the HSE any claim against the estate of the deceased?
4.
5.
6.
Y
es No
Y
es No
Length of Term
-
YMYY M
Description of holding
Name of beneficiary
*
Indicate who paid the premiums, if not the deceased alone
Not
y
et Ascertained
0106100592
Place in the appropriate box
Where the answer to any of questions 7 - 12 is Yes, provide below (in the panel which follows question 12) a
statement giving full particulars including details of the property and its value and the names and addresses of the
beneficiaries and trustees (if any).
Y
es No
7. Was the deceased at the date of death the owner of a limited interest (e.g. an annuity, right of residence, or an
interest for life or otherwise in house, lands, securities etc.)?
9. Did the deceased at any time make a disposition:
(a) subject to a power of revocation;
(b) by way of surrender (for full consideration or otherwise) of a limited interest;
(c) allowing (on or after 5 December, 1991) the use of any property free of charge or for other than full consideration?
10.
(
a
)
Did the deceased create a discretionar
y
trust:
(i) during his or her lifetime, or
(ii) under his or her will?
(b) Are any Principal Objects named as objects in a discretionary trust? (For the definition of Principal
Objects please see the guide CA25 on the Revenue website at www.revenue.ie).
If Yes, state date of birth of each
DD MM YYYY
/ /
DD MM YYYY
/ /
11. Was the deceased entitled at the date of death to an interest in expectancy in any property?
12. Did any person become entitled on the death of the deceased to an interest in any property by virtue of the
deceased's exercise of or failure to exercise a general power of appointment?
FULL PARTICULARS
(applicable if the answer to any of questions 7 - 12 above is Yes)
Page 14
Form CA24
DD M M Y Y Y Y
/ /
8. Did any person, on or after 5 December, 1991 under a disposition (e.g. a transfer or settlement) at any time
made by the deceased, take:
(a) a gift, or
(b) any other benefit in possession (other than property disclosed in Part 4 or 5 or in reply to
questions 1, 2 or 3 in this Part)?
e.g. the taking of a remainder interest on the death of a life tenant.
*
*
1206100594
Page 15
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Is any of the property described below agricultural property which consists of trees or underwood
Is the estimated value supported by a professional valuation
Enter the property number to which this relates
Litres
If so, identify clearly the lands involved by entering
The value of the lands should include the value of the trees and underwood
Milk Quota
Y
es No
Timber
Pro
p
ert
y
2
Propert
y
1
Part 7 Schedule of lands and buildings
the property number to which this relates
Is there a super levy milk quota attached to any of the property described below
Place in the appropriate box
SITUATION OF PROPERTY
County:
City:
Town:
Townland or
Street and No.
Electoral Division or
Ward
Agricultural
Development
Residential
Commercial
Mix
Single Site
Residential
Commercial
Retail
Industrial
Office
Agricultural
Mix
{
Tenure
J
Leasehold
Freehold
J
Lands
Buildings
Place in the appropriate box
Place in the appropriate box
Len
g
th of Term
-
Y Y Y M M
DD MM YYYY
Date of lease
/ /
If registered, folio number
Place in the appropriate box
SITUATION OF PROPERTY
County:
City:
Town:
Townland or
Street and No.
Electoral Division or
Ward
Agricultural
Development
Residential
Commercial
Mix
Single Site
Residential
Commercial
Retail
Industrial
Office
Agricultural
Mix
{
Tenure
J
Leasehold
Freehold
J
Lands
Buildings
Place in the appropriate box
Place in the appropriate box
Len
g
th of Term
-
Y Y Y M M
DD MM YYYY
Date of lease
/ /
Place in the appropriate box
Estimated market
value of property
Millions Thousands Hundreds
, ,
Estimated market
value of property
Millions Thousands Hundreds
, ,
If registered, folio number
0155100596
Page 16
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Property 3
Property 4
Pro
p
ert
y
5
Place in the appropriate box
SITUATION OF PROPERTY
County:
City:
Town:
Townland or
Street and No.
Electoral Division or
Ward
Agricultural
Development
Residential
Commercial
Mix
Single Site
Residential
Commercial
Retail
Industrial
Office
Agricultural
Mix
{
Tenure
J
Leasehold
Freehold
J
Lands
Buildings
Place in the appropriate box
Place in the appropriate box
Len
g
th of Term
-
Y Y Y M M
DD MM YYYY
Date of lease
/ /
If registered, folio number
Place in the appropriate box
SITUATION OF PROPERTY
County:
City:
Town:
Townland or
Street and No.
Electoral Division or
Ward
Agricultural
Development
Residential
Commercial
Mix
Single Site
Residential
Commercial
Retail
Industrial
Office
Agricultural
Mix
{
Tenure
J
Leasehold
Freehold
J
Lands
Buildings
Place in the appropriate box
Place in the appropriate box
Len
g
th of Term
-
Y Y Y M M
DD MM YYYY
Date of lease
/ /
If registered, folio number
Place in the appropriate box
SITUATION OF PROPERTY
County:
City:
Town:
Townland or
Street and No.
Electoral Division or
Ward
Agricultural
Development
Residential
Commercial
Mix
Single Site
Residential
Commercial
Retail
Industrial
Office
Agricultural
Mix
{
Tenure
J
Leasehold
Freehold
J
Lands
Buildings
Place in the appropriate box
Place in the appropriate box
Len
g
th of Term
-
Y Y Y M M
DD MM YYYY
Date of lease
/ /
If re
g
istered
,
folio numbe
r
Estimated market
value of property
Millions Thousands Hundreds
, ,
Estimated market
value of property
Millions Thousands Hundreds
, ,
Estimated market
value of property
Millions Thousands Hundreds
, ,
4285100594
Page 17
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Self Assessment return Form IT38 is required for each beneficiary where the value of the current benefit, when
added to the prior aggregable benefits within the same Group Threshold, exceeds 80% of that threshold.
PPS No. of
deceased
Part 8 Summary of Benefits. Include all current benefits exceeding €16,750. Exclude benefits taken by a spouse or civil partner.
All tax related
q
ueries should be addressed to the Office of the Revenue Commissioners. Contact details are available on www.revenue.ie
BENEFICIARY DETAILS
BENEFICIARY DETAILS
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
Millions Thousands Hundreds
Millions Thousands Hundreds
7522100591
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Page 18
Form CA24
BENEFICIARY DETAILS
BENEFICIARY DETAILS
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
Self Assessment return Form IT38 is required for each beneficiary where the value of the current benefit, when
added to the prior aggregable benefits within the same Group Threshold, exceeds 80% of that threshold.
All tax related queries should be addressed to the Office of the Revenue Commissioners. Contact details are available on www.revenue.ie
Millions Thousands Hundreds
Millions Thousands Hundreds
2085100590
Page 19
Form CA24
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Self Assessment return Form IT38 is required for each beneficiary where the value of the current benefit, when
added to the prior aggregable benefits within the same Group Threshold, exceeds 80% of that threshold.
BENEFICIARY DETAILS
BENEFICIARY DETAILS
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
All tax related queries should be addressed to the Office of the Revenue Commissioners. Contact details are available on www.revenue.ie
Millions Thousands Hundreds
Millions Thousands Hundreds
5290100591
Page 20
A
ll considerations to be stated in whole EURO only. Do not enter Cent.
Form CA24
BENEFICIARY DETAILS
BENEFICIARY DETAILS
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
Place in the appropriate box if the
Beneficiary is Irish Resident or is
Ordinarily Resident in the State.
PPS No. of
Beneficiary
Forename
Where any prior Aggregable Benefits have been received since 05/12/1991 state the amount received under that threshold. Where no amount
please enter 0.
Surname
DD MM YYYY
DD MM YYYY
A
ddress
A B C
CURRENT BENEFIT
(
S
)
Group threshold
, ,
Place in the appropriate box
Grou
p
threshold
, ,
, ,
Threshold A
A
pproximate value
Threshold B
A
pproximate value
Threshold C
A
pproximate value
Approximate value (include benefits passing by survivorship)
, ,
Y
es No
Self Assessment return Form IT38 is required for each beneficiary where the value of the current benefit, when
added to the prior aggregable benefits within the same Group Threshold, exceeds 80% of that threshold.
All tax related queries should be addressed to the Office of the Revenue Commissioners. Contact details are available on www.revenue.ie
Millions Thousands Hundreds
Millions Thousands Hundreds
5009100599
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Form CA24: INLAND REVENUE AFFIDAVIT (Irish Tax & Customs)

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Completed 23 August 2020

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