Application Form

Your Details	(Mandetory())*
First Name 1*
Surname*
Address Line1*
Address Line2
Address Line3
Town*
County/Province*
Post Code*
Country*
Fiscal Number (N.I.E.)*
Current Passport Number*
Nationality*
First Name 2
Surname
Address Same as Above
Address Line1
Address Line2
Address Line3
Town
County/Province
Post Code
Country
Fiscal Number (N.I.E.)
Current Passport Number
Nationality
Other Owners (if applicable)
Telephone Number
Fax Number
Email Address*

Property Details
Property Address*
Property Location (Town)*
Property Post Code*
Property County/Province*
Date Property Purchased*	/ / (dd/mm/yy)
Price in the Public Deeds*
Date Property Sold* (must be between 2002 - 2006 to be eligible for a rebate)	/ / (dd/mm/yy)
Sale Price in the Public Deeds*
Tax Paid (Capital Gains Tax)
Date Tax Paid	/ / (dd/mm/yy)
Did you pay during your ownership of the property the Non Residents Wealth and Income Tax.* (Tax Form 214)	Yes No
Comments:

Your Details