United Kingdom / Ireland Double Taxation Convention (SI 1976 No. 2151 and Protocols)
Claim to relief from United Kingdom Income Tax
For use by a company or concern, resident in Ireland receiving interest, royalties
or other income arising in the UK
Please:
• usetheattachedIreland-CompanyNotestohelpyoufillinthisform
• giveallthedetailsaskedforintheform
• signtheDeclarationinPartFandsaywhatisyourstatusinthecompanyorconcern
• seeNote4forinformationaboutwheretosendthecompletedformIreland-Company
Ifyouneedhelpwiththisform,pleasecontactHMRevenueandCustoms,LargeBusinessDTTreatyTeam,
BarkleyHouse,CastleMeadowRoad,Nottingham,EnglandNG21BA.
Telephone:+44(0)3000547584ifcallingfromoutsidetheUK,or03000547584ifcallingfromtheUK.
Websitewww.gov.ukandlookfordoubletaxationforoverseasconcernsinthesearchfacility.
Form Ireland-Company
Full name of the company/concern receiving
the income
___________________________________________
Full registered address
Don’tuse‘careof’address
___________________________________________
___________________________________________
___________________________________________
Telephone number__________________________
Fax number________________________________
Reference (if any)
or contact name _____________________________
Ifthecompanyorconcernhasataxadviser,please
givedetails.SeeNote5.
Adviser’s name
___________________________________________
Adviser’s address
___________________________________________
___________________________________________
___________________________________________
Telephone number__________________________
Fax number________________________________
Reference (if any)
or contact name _____________________________
Part A Details of the company or concern and tax adviser (if any)
Pleasegive:
• thecompany’sIrishtaxreference
• theaddressofthetaxofficeinIrelandwherethe
company’slatesttaxreturnwassent
• thedateonwhichitwassent
IfthecompanyfilesaconsolidatedtaxreturninIreland,pleasegive:
• thenameoftheparentcompany
• itsIrishtaxreference
For use by the Inspector of Taxes in Ireland
PleasesignandaffixyourofficialstampandthensendthisformtoHMRevenueandCustoms,LargeBusiness
DTTreatyTeam,BarkleyHouse,CastleMeadowRoad,Nottingham,EnglandNG21BA.Youmaywishtotakea
copyofthisformforyourrecords.
Icertifythat______________________________________
isaresidentinIrelandforthepurposeofIrishtax.
Signature_________________________ Date___________
OfficialStamp
click to sign
signature
click to edit
Part B Questions about the Irish company
PleaseanswerthefollowingquestionsabouttheIrishcompany.Ifyou’recompletingthisformonbehalfofan
Irishpensionfund,charity,partnershiporotherconcern,pleaseanswerthequestionsastheyapplytotheconcern.
SeeNote2.
P’whereappropriate
1 Isitacompanycreatedin,ororganisedunderthelawsof,Ireland? Yes
No
2 Whereisthecompany’sbusinessmanagedandcontrolled?
3 Isthisthecompany’sfirstclaimofthiskind? Yes No
4 Isthecompanyengagedinanytradeorbusiness,fromapermanent Yes  No
establishmentorfixedbasesituatedintheUK?
If‘Yes’,givefulldetailsonaseparatesheet,includingthenameand
referencenumberoftheUKtaxofficedealingwiththepermanent
establishmentorfixedbase.
5 IsthereanyrelationshipbetweenthecompanyandtheUK Yes
 No
payeroftheincome,otherthanthatofpayeeandpayer?
If‘Yes’,givefulldetailsonaseparatesheet.
6 Isthebeneficialowneroftheincomethatisthesubjectofthisclaiman Yes
 No
‘exemptapproved’pensionschemeorcharity?
Ifyou’recompletingthisformonbehalfofapartnershiportrust,answerquestion7andifappropriate,8.
Otherwise,godirecttoquestion9.
7 IstheincomeincludedinthisclaimsubjecttoIrishtaxinthehandsofthe Yes
 No
individualpartners,participantsorbeneficiaries?
If‘No’,pleaseanswerQuestion8.
8 IsthepartnershiportrustsubjecttoIrishtaxontheincomethatisincluded Yes
 No
inthisclaim?
Ifyouanswered‘No’toQuestion7and‘No’toQuestion8,pleasesayona
separatesheet,whythepartnershiportrustisentitledtoreliefunderthe
UK/IrelandDoubleTaxationConvention.
9 Onwhatdatedoesthecompany’saccountingperiodendeachyear?
If,exceptionally,adifferentyearenddateappliestotheincomeshown(ifany)
inPartDofthisform,givefulldetailsintheboxbelow.Attachaseparatesheet
ifyouneedmoreroom.
Day Month Year
dd mmm yyyy
Part C Application for relief at source from UK Income Tax
UsePartC.1,C.2,C.3orC.4asappropriate,toapplyonbehalfofthecompanyorconcernforreliefatsourcefrom
UKIncomeTax.
IfthecompanyorconcernhasalreadyreceivedpaymentsoftheincomewithUKIncomeTaxdeducted,pleasealso
completePartDtoclaimrepaymentofthetax.
C.1 Interest from loans
Completethecolumnsbelowgivingtheinformationrequestedandattachacopyoftheloanagreementto
thisform.
Name and address of the UK payer of the interest
Ifpossible,pleasealsogivethenameofacontactdealing
withtheinterestpayments.
Date of the
loan agreement
Amount of
the loan
Due date(s) of
the interest
C.2 Interest from UK securities
Pleasecompletethecolumnsbelow,givingtheinformationrequested.
Amount and full title
of security
Name and address in which
security is registered
Registrar’s account number
or reference
Due date(s) of
the interest
C.3 Royalties
Completecolumns1to3asappropriate,givingtheinformationrequested.
Column 1 Column 2 Column 3
(‘P’whereappropriate)
IstheIrishcompanytheoriginatoroftheworkorproductthathasbeenlicensed Yes
 No
totheUK?
If‘No’,pleaseattachacopyofthelicence,contractorassignmentunderwhichtherightssub-licensedtotheUK
payerhavebeenacquiredfromtheoriginator.
Forcopyrightroyaltiesonliterary,dramatic,musicalor
artisticworks:
• enterincolumn1afulldescriptionoftheroyalties
• enterincolumn2thedateofthelicenceagreement
betweenthecompanyandtheUKpayer
• enterincolumn3thepayer’snameandaddress
Ifpossible,alsogivethenameofacontactdealingwith
theroyaltypayments.
IfpaymentsaremadethroughorbyanagentintheUK,
alsoentertheagent’snameandaddress.
Forotherroyalties:
• enterincolumn1afulldescriptionoftheroyalties
• enterincolumn2thedateofthelicenceagreement
betweenthecompanyandtheUKpayerandattacha
copyofthelicenceagreement
• enterincolumn3thenameandaddressoftheUK
payeroftheroyalties
Ifpossible,alsogivethenameofacontactdealingwith
theroyaltypayments.
C.4 Irish charity or Irish pension fund - income from UK property
UsethispartonlyforanIrishcharityorIrishpensionfundreceivingrentalincomefromtheUK.
Ifyouarecompletingtheformonbehalfofapensionfund,pleaseseeNote9aboutconfirmationof
‘exemptapproved’status.
Name and address of the person in the UK who deducts tax from the rental income Date(s) rental
income is payable
Part D Claim for repayment (where appropriate)
IftheIrishcompanyorconcernhasalreadyreceivedpaymentsofincomewithUKtaxdeducted,pleasegivedetails
belowtoclaimrepaymentundertheUK/IrelandDoubleTaxationConvention.
Ifnopaymentsoftheincomehaveyetbeenmade,godirecttotheDeclarationinPartF.
Source of income
Forexample‘Copyrightroyaltiespaidby[nameofpayer]’
Date of
payment of
income
Amount of
income before
UK tax
£
Amount of
UK tax
deducted
£
Totals
Part E Repayment instructions
Completethispartifyouwantustomaketherepaymenttoabankorothernominee.Ifyouleavethispartempty,the
repaymentwillbemadedirecttothecompanyattheaddressyouhaveshowninPartAofthisform.
I,
(Enteryourfullname)
as
(Enterstatus–forexample,companysecretary,treasurer,orauthorisedagent)
of
(Enternameoftheclaimantcompanyorconcern)
authorisethebankorothernomineebelowtoreceivetheamountdueonthecompany’sbehalf.
Nameofbankorothernominee
Addressofbankorothernominee
Postcode
Accountname
Accountnumber UKbanksortcode
(ifappropriate)
Nominee’sreferencenumber(ifthereisone)forthecompany
Signature______________________________(nowalsocompleteandsigntheDeclarationinPartFbelow)
click to sign
signature
click to edit
Part F Declaration
P’asappropriate
1. TheinformationIhavegivenonthisclaim/applicationis,tothebestofmyknowledgeandbelief,
correctandcomplete.
2. IhaveconsideredtheguidanceonbeneficialownershippublishedatINTM332040by
HMRevenueandCustomsandhaveconcludedthat
(a) thecompanyorunincorporatedconcernisbeneficiallyentitledtotheincomefromthesource(s)includedin
thisformorotherwisemeetstheconditionsforreliefintheDoubleTaxationConvention
betweentheUKandIreland
or
(b) thecompanyorconcernisnotthebeneficialowneroftheincomebutisentitledtorelieffrom
UKtaxundertheDoubleTaxationConventionforthereason(s)Ihavegivenintheattachednote.
On behalf of the company or concern
3.IapplyforreliefatsourcefromUKIncomeTaxandundertaketotellHMRevenueandCustoms(HMRC)if
thereisanychangetotheinformationthatIhavegiveninthisform.(SeeNote6)
4.IclaimrepaymentofUKIncomeTaxand
(a)haveworkedoutthattheamountpayable
tothecompanyorconcernis
or
(b)wantHMRCtoworkouttheamountpayabletothecompanyorconcern.
*Signature _____________________________________________Date____________________
Printyournamebelowandenteryourstatus.
*Who may sign
Foracompanyorfund,aresponsibleofficerofthecompanyorfundmaysign.Anagent(taxadviser),‘custodian’or
otherdulyauthorisedpersonactingwiththeauthorityofthecompanymayalsosignonthecompany’sbehalf.
Forapartnership,thesenior,generalormanagingpartner(asappropriate)maysigninthenameofthepartnership.
PleaseseeNote3andattachtotheclaimalistgivingthenamesandresidentialaddresses(orregisteredbusiness
addressesifcompanies)ofallthepartners,andeachpartner’spercentageshareinthepartnership.
For official use by HM Revenue and Customs
Amountrepaid:
Examined______________________________________ £___________________:___
Authorised_____________________________________
HMRCdatestamp
©Crowncopyright2017
Important: pleasereadNote2intheattachedIreland-CompanyNotesbeforecompletingthisdeclaration.
*Entertheamountpayablethatyouhave
workedout.Leavetheboxemptyifyou
wantHMRCtoworkouttheamount.
click to sign
signature
click to edit
Ireland-Company Notes
UsethesenotestohelpyoucompleteformIreland-Company.Ifyouneedfurtherinformation,pleasecontact
HMRCLargeBusinessTreatyTeam.Ouraddress,phoneandfaxnumbersareinNote11.
1. Purpose of form Ireland-Company
FormIreland-Companyenables:
• anIrishcompany
• anunincorporatedconcernsuchasapensionfund,partnership,inIreland
receivinginterestorroyaltiesarisingintheUKtoapplyforreliefatsourcefromUKIncomeTaxunderthe
UK/IrelandDoubleTaxationConvention.TheformalsoprovidesforaclaimtorepaymentofUKIncomeTaxincases
wherepaymentsoftheincomehavebeenmadewithUKtaxdeducted.
2. Beneficial ownership
TheUK/IrelandDoubleTaxationConventionprovidesforrelieftobeavailabletothebeneficialowneroftheincome.
Whereaclaimantisrequiredtopassontheincomeinrespectofwhichtheclaimismadeitmaynotbethebeneficial
owneroftheincomeforthepurposesoftheDoubleTaxationConvention(DTC).PleaseseetheHMRCguidance
publishedinourInternationalManual(INTM).Toreadtheguidanceonlinegotowww.gov.ukandlookfor
InternationalManualinthesearchfacility.TherequiredinformationisatINTM332000onwards.
Wherethecompanyorconcerndoesn’tsatisfythe‘internationalfiscalmeaning’ofbeneficialownershipbutbelieves
thatbecauseofthepolicystatementsthataremadeintheguidanceitisstillabletoobtaintreatybenefits,youshould:
• tickbox2(b)inthedeclarationinPartFoftheform
• includewiththeclaimanotegivingtheinformationmentionedatINTM332070–reproducedbelowfor
easeofreference
“WherestructuresarewithintheambitoftheIndofooddecision,thatistosaythestructurehastheaccessingof
treatybenefitsasoneofitseffects,itispossiblethatapplicationstoHMRCforbenefitsunderaDoubleTaxation
Convention(DTC)willfallatthefirsthurdleunlesstheapplicantcandemonstratebeneficialownership.The
applicationmightsimplyberegardedasinvalidandneverreachthestagewhereitcanbeconsideredintermsof
theobjectandpurposeoftheparticularDTCunderwhichtheapplicationismade.
However,wheretheclaimantSpecialPurposeVehicle(SPV)doesnotsatisfythe“internationalfiscalmeaning”of
beneficialownershipbutbelievesthatitisstillabletoobtaintreatybenefitsbecauseofthepolicyconfirmedinthis
guidance,itshouldmakeitsclaimandincludeanotetothateffect.Toeaseconsiderationoftheclaim,thenote
shouldincludefulldetailsasto:
• afullstructurediagramandexplanationofthecapitalandinterestflows
• whytheSPVisconsideredtobethebeneficialownerwithinthe“internationalfiscalmeaning”
• demonstratethatthestructuredoesnotabusetheDTCunderwhichtheclaimismadeeitherrelatingthe
structuretotheexamplesatINTM332080orotherwise”
Whereaclaim/applicationforrelieffromUKtaxismadebyapartnershiporotherconcernthatisnotataxableperson
orisotherwise‘transparentfortaxpurposes’underthelawofitscountryofresidence,youshouldtickbox2(b)in
theDeclarationinPartFoftheformIreland-CompanyandprovideadditionalinformationasoutlinedintheHMRC
guidanceatINTM335500.
3. Claims on behalf of partnerships
TheUK/IrelandDoubleTaxationConventiondoesn’tgivetherighttoclaimrelieftopartnershipsandLLCswhere
thesearetax-transparent.Instead,inthosecaseswheretheincomeoftheconcernistaxableinthehandsofits
partnersormembers(ratherthanattheleveloftheconcernitself)eachofthoseshouldinstrictnessmakeaseparate
claimtotreatyrelief.
HMRCrecognisesthatadoptingthisstrictapproachmayimposeanunreasonableadministrativeburdenonclaimants
whichisn’tneededinmanycasestogiveeffecttotheintentandpurposeofthetreaty.
Insuchcases,andwithoutprejudicetoourrighttorequireindividualclaims,we’llnormallybepreparedtoaccepta
single(composite)claiminthenameofthepartnershiporLLC.Thismustincludethefollowingfeatures,inadditionto
thenormalinformationthatisrequiredbytheformIreland-Company:
• inallcasesthegeneralormanagingpartner/membershouldsignthedeclarationinPartFof
formIreland-Company
• wherethepartnershiporLLCisestablishedinIrelandandallofthepartners/membersareresidentfortaxpurposes
inIreland,attachtotheclaimalistofthenamesandaddressesofthepartners/members-thelistshouldshow
residentialaddressesforindividualsandregisteredaddresseswherethepartners/membersarecompanies
• whereanypartner/memberisresidentfortaxpurposesinacountryotherthanIreland,attachthelistdescribed
above-thelistmustalsoincludeforeachmember/partnertheirrespectivepercentageshareoftheincomethatis
thesubjectoftheclaim
Anypartner/memberresidentfortaxpurposesoutsideIrelandwillalsoneedtomakeaseparateclaimtorelief
fromUKtaxunderthetermsofanyrelevantDTC.TheDigestofDoubleTaxationTreatieslistsalloftheUK’s
comprehensiveDTCs.ToreadtheDTDigestonlinegotowww.gov.ukandlookforTreatyDigestin
thesearchfacility.
4. Evidence of residence in Ireland and where to send the completed form
ItisaconditionofrelieffromUKIncomeTaxunderthetermsofUK/IrelandDoubleTaxationConventionthatthe
beneficialowneroftheincomeisresidentinIreland.TheIrishRevenueCommissionerswillthereforeneedtocertify
thatthecompanyorconcernisresidentinIrelandforthepurposesofIrishtax.
IfyouhavecompletedtheformIreland-Companyonbehalfof:
• acompany,sendtheformtotheIrishInspectorofTaxestowhomthecompany’slatesttaxreturnwassent
• acharity,sendtheformtotheCharitiesSection,OfficeoftheRevenueCommissioners,GovernmentOffices,
Nenagh,Co.Tipperary,Ireland
• apensionfund,sendtheformtotheFinancialServicesPensionsDistrict,OfficeoftheRevenueCommissioners,
LargeCasesDivision,BallaughHouse,73to79LowerMountStreet,Dublin2,Ireland-pleaseenclosea
photocopyofthecompletedform.(Confirmationof“exemptapproved”statusisalso
required-seeNote9)
TheappropriateofficewillcertifytheformandsenditdirecttoHMRC.
5. Confidentiality
AlltheinformationthatyouprovidetoHMRCisconfidential.Wecanthereforeonlydiscussthetaxaffairsofthe
companyorconcernwith:
• anofficerofthecompany
• anyagent(forexampleataxadviser)whoisnominatedbythecompanyorconcern
6. Relief at source from UK Income Tax on future income payments
ReliefatsourcefromUKIncomeTaxonfuturepaymentsofincomemaybeavailableincaseswhereHMRCisable
toexerciseitsdiscretiontoissueanotice(underStatutoryInstrument1970Number488,asamended).HMRCdeals
witheachapplicationonitsmerits.Wherewecannotagreetoallowreliefatsource,acompanyorconcernresidentin
IrelandcanclaimrepaymentoftheUKtaxdeducted.
Ifreliefatsourceisgranted,pleasetellHMRCattheaddressinNote11withoutdelay,ifthereisanysubsequent
changetotheinformationyouhavegivenontheformIreland-Company.
7. UK Interest
Interest from loans
WheretheinterestispayableonaloantoaUKresidentcompanyorindividual,pleaseattachacopyoftheloan
agreementtotheformIreland-Company.
Interest from securities
UKtaxisdeductedfrominterestonloanstocksissuedby:
• companieswhicharenotquotedontheStockExchange
• localauthorities
WemaybeabletoarrangeforinterestonthesestockstobepaidwithnoUKtaxdeducted,asexplainedinNote6.
InterestfromthefollowingUKsourcesispaidwithnoUKtaxdeducted,sothereisnoneedtoapplyforrelieffromUK
taxatsource.Pleasedon’tenterinPartC2offormIreland-Company:
• interestfromcompanyloanstocksquotedontheStockExchange(paidautomaticallywithoutdeductionofUKtax)
• interestfromUKgovernmentsecurities(paidautomaticallywithoutdeductionofUKtax)
8. UK royalties
TheDTCallowsreliefonlytothebeneficialowneroftheroyalties.Thebeneficialownerisnormallytheoriginatorof
theworkorproduct.
Copyright royalties for literary, dramatic, musical or artistic works
Ifyourcompanyorconcernisnottheoriginatorbuthasacquiredtherights,pleaseattachtotheform
Ireland-Companyacopyofthelicence,contractorassignmentunderwhichtheUKrightshavebeenacquired.
ThiswillhelpHMRCtocheckthatthebeneficialownershipconditionintheDTCissatisfied.
Ifyourcompanyorconcernisinthepublishingormusicbusinessandusesastandardformofcontractwith
allitsauthorsorcomposers,pleaseattachacopyofthestandardcontract.Youneeddothisonlythefirsttimea
formIreland-Companyiscompleted.
Other royalties
WhereyourcompanyorconcernistheoriginatorofaprocessordesignpleaseattachtotheformIreland-Companya
copyofthelicenceagreementbetweenyourselvesandtheUKpayeroftheroyalties.Ifyourcompanyorconcernis
nottheoriginatoroftheproductgivingrisetotheroyaltiesbuthasacquiredtherights,pleasealsoattachacopyofthe
licence,contractorassignmentunderwhichtheUKrightshavebeenacquired.
9. Irish pension funds and Irish charities receiving rental income from UK property
TheUK/IrelandDoubleTaxationConventionprovidesfortaxexemptIrishcharitiesandIrishpensionfundstoreceive
rentalincomeformUKpropertywithoutdeductionofUKIncomeTax.Ifyou’recompletingtheformonbehalfofan
IrishcharityorIrishpensionFundthatreceivesUKrentalincome,pleasegivefulldetailsinPartC.4.
PensionfundsshouldalsoprovidealetterofconfirmationfromtheIrishtaxauthoritiesthatthefundis‘exempt
approved’.ThislettershouldberequestedfromFinancialServicesPensionsDistrict,OfficeoftheRevenue
Commissioners,LargeCasesDivision,BallaughHouse,73to79LowerMountStreet,Dublin2,Ireland.
10. Tax vouchers
Don’tsendtaxvoucherswiththecompletedformIreland-Company.Keepthemsafeincasetheyareneededlaterto
supporttheclaim.Butifyouhaveanydoubtabouthowyouhavecompletedtheformyoucansendthevouchersif
youthinkitwillhelpus.
11. Help or more information
If,afterusingthesenotesyouneedhelpormoreinformation:
• gotowww.gov.ukandlookfordoubletaxationforoverseasconcernsinthesearchfacility
• telephone:+44(0)3000547584(HMRCLBDTTreatyTeam)ifcallingfromoutsidetheUK,or03000547584
ifcallingfromtheUK
• writetoHMRevenueandCustoms,LargeBusinessDTTreatyTeam,BarkleyHouse,CastleMeadowRoad,
Nottingham,EnglandNG21BA
Ourfaxnumberis+44(0)3000564002fromoutsidetheUK,or03000564002frominsidetheUK.
Pleasequotethecompany’sreferencenumber(forexample‘12/A/123456’)wheneveryoucontactus.
ThesenotesareforguidanceonlyandreflecttheUKtaxpositionatthetimeofwriting.Theydon’t
affectanyrightsofappeal.
July2017 ©Crowncopyright2017
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