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Agent Link Notification Form - Revenue

RPC014917_EN_WB_L_1 Agent link NotificationClient name (Block capitals)Tax Reference NumberAgent TAIN I confirm that with effect from is to act as my Agent in respect of the following taxes (insert x as appropriate): Income Tax (incl. PAYE) [See Note 1]Corporation Tax (CT)Value Added Tax (VAT)Employer's PAYE / PRSI - (Financial & Payroll Agent )Employer's PAYE / PRSI - (Payroll Only Agent )Capital Gains Tax (CGT)Relevant Contracts Tax (RCT)Environmental Levy (E Levy)Dividend Withholding Tax (DWT)VAT Member State of Identification (VMSI)Other: SpecifyNote 1: This includes clients with both PAYE and IT sources of income.

as my agent in respect of the following taxes (insert x as appropriate): Income Tax (incl. PAYE) [See Note 1] Corporation Tax (CT) Value Added Tax (VAT) Employer's PAYE / PRSI - (Financial & Payroll Agent) Employer's PAYE / PRSI - (Payroll Only Agent) Capital Gains Tax (CGT) Relevant Contracts Tax (RCT) Environmental Levy (E Levy)

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