Fillable Printable Application for a Refund of Motor Tax
Fillable Printable Application for a Refund of Motor Tax
Application for a Refund of Motor Tax
APPLICA
TION FOR
A
REFUND OF MOT
OR T
AX
R
F120
T
ax Disc must be surrendered immediately as refunds are generally calculated from the first of the month following the surrender of the disc.
A
minimum of 3 unexpired whole calendar months must be left on the disc when surrendered.
A
.
OWNER / VEHICLE DET
AILS
1. REGISTRA
TION NUMBER
Make / Model
Chassis Number
OWNER
Mr
., Ms., etc.
Surname OR Company Name
Address
Town / City
County
Colour(s)
First Name(s)
Phone No.
1. Vehicle Stolen
The vehicle was stolen on
B. REASONS FOR REFUND
*5. V
ehicle not used because of Owner
’
s Illness / injury
I, the owner of the vehicle have
and has not since been recovered
2. V
ehicle Scrapped / Destroyed
The vehicle was scrapped
completely and destroyed on
and is incapable of being used
on the roads
D
ay
Month
Y
ear
Day
Month
Y
ear
ceased to use it from
because of illness, injury or other
physical disability and I will be unable
to use until at least
Day
Month
Y
ear
Day
Month
Y
ear
3. Vehicle Exported
The vehicle was sent
permanently out of the state on
Day
Month
Y
ear
*6. V
ehicle unused because the Owner absent from the State
I, the owner of the vehicle have
ceased to use it from
4. Vehicle Not Used
The vehicle has not been used in a public place at any time
since the
issue
of the tax disc.
Because of absence from the State
for business / educational purposes or
overseas service with the Defence
Forces. I will be absent from the
state until
Day
Month
Y
ear
Day
Month
Y
ear
Documents to
Accompany
Application:
In all cases T
ax Disc and Vehicle Licensing Certificate or
Registration (Log) Book
*
Medical certificate, letter from educational body or business etc.,
confirming the relevant period.
*7. V
ehicle Duty Error
The duty was paid / overpaid by mistake in the following
circumstances
...............................................................................................................
...............................................................................................................
C. DECLARA
TION
I
declare that the particulars given at ‘A
’
above are correct and I apply for a refund of motor tax for the reason (tick) given at
B. I attach the required
evidence (Medical Certificate, etc as appropriate) in support of my claim and I further declare that the vehicle in respect of which the refund is being
sought will not be used by me or with my consent in any public place during the remainder of the licensing period unless it is properly licenced.
Signature of Owner:
............................................
Signature of Garda / Witness:
............................................
Date:
............................................
Garda Station Stamp
D. FOR OFFICIAL
USE ONL
Y
Serial Number of
Application
.........................................................
Date of Surrender of Licence
.........................................................
Date of Expiry of Licence
.........................................................
Number of months remaining
.........................................................
Annual Rate of
T
ax
.........................................................
Repayment / Refund
Amount
.........................................................
Date
Allowed / Disallowed
.........................................................
Date Repaid / Refunded
.........................................................
.........................................................
