Please complete relevant sections in BLOCK CAPITALS
form 12AApplication for a Certificate of Tax Credits and Standard Rate Cut-Off PointPlease complete relevant sections inBLOCK Personal DetailsTitleFirst NameSurnameAddressDate of BirthNationalityPPS Number(See Note 3 on help sheet)If you have a PPS provide it, give:Your Birth Surnameif differentYour mother s birth SurnameB. Residence Details(see note 3 on Help Sheet)If you lived outside the State during the last 24 months Please state:Date you went abroadDate of arrival/return(if an Irish National)to the StateCountry of residence prior toIntended duration of your stayarrival here( number of months/years)Are you here on a Permanent or Temporary Basis ( Please tick ):PermanentTemporaryC.
Form 12A Application for a Certificate of Tax Credits and Standard Rate Cut-Off Point Please complete relevant sections in BLOCK CAPITALS. A. Personal Details Title
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