Designed by the Revenue Printing Centre
RPC014163_EN_WB_L_1
Waiver of Residency Application Form
Disabled Drivers / Passengers (Tax Concessions) Regulations 1994
APPLICANT PRIMARY MEDICAL CERTIFICATE HOLDER
Name:
PPSN:
Address:
(include
Eircode)
Name:
PPSN:
Address:
(include
Eircode)
I, ……………………………………............ (applicant) wish to apply for waiver of the residency
requirement under the above regulations, as per section 7.2 of Information Booklet VRT 7
Signature: …………………………………….. Date: ……………………………………...........
Supporting documentation from at least two sources conrming that the applicant is responsible
for the transport and care of the Primary Medical Certicate holder should be submitted with this
application.
Suggested sources:
1. Social Worker.
2. G.P.
3. Garda Authorities.
4. Nursing Home (dates of transport for previous twelve months to be included).
5. Department of Employment Affairs and Social Protection (Carers Allowance recipient).
The completed application form should be sent via MyEnquiries to the:
Central Repayments Ofce
Freepost
M: TEK II Building
Armagh Road
Monaghan
H18 YH59
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