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TERMS AND CONDITIONS I, the undersigned, declare to the revenue commissioners that ‘’My Tax Back Ltd’’ act as my agent with Agent TAIN: 76420B with regard to all aspects of Income tax. I understand that this agreement will remain in place until such time as either party, the client or the agent, has notified the Revenue Commissioners of Ireland of their wish to cancel this agreement. 2. Authorisation for Agent to receive refunds on behalf of client I authorise the transfer of any refund or repayment of PAYE/Income Levy/Universal Social Charge due to me by the Revenue Commissioners by electronic funds transfer to the following bank account which is held ‘’My Tax Back Ltd’’: Name of Account Holder: My Tax Back IBAN: IE39AIBK93718516961062 BIC: AIBKIE2D I understand that any refund made by Revenue Commissioners to my agent, (My Tax Back Ltd), on my behalf is refunded in a similar manner as if same were being refunded directed to me and that once the refund is transferred into the bank account nominated by me, I have no further call upon the Revenue Commissioners in respect of same. I understand that (My Tax Back Ltd) is acting as my agent and is solely responsible to me in respect of any refund received by them on my behalf. I further understand that my agent (My Tax Back Ltd) is an independent entity and the Revenue Commissioners make no endorsement of my agent of any such agency cannot accept any responsibility whatsoever for problems encountered by me in dealing with them. I understand and agree that the tax agent (My Tax Back Ltd) will input its own bank account details on the Revenue record for this process. I confirm that I am aware of, and agree to, the payment of the fees charged by the tax agent (My Tax Back Ltd) in respect of the services carried out on my behalf and that this fee will be deducted from any amount refunded by the Revenue Commissioner and the balance of the amount will be paid to me. 3. Terms and conditions of Authorisation I understand that tax law provides for both civil penalties and criminal sanctions for the failure to make a return, the making of a false return, facilitating the making of a false return, or claiming tax credits, allowances or reliefs that are not due. I confirm that I will provide the necessary documentation to the tax agent (My Tax Back Ltd) to support any refund made to the agent (My Tax Back Ltd) on my behalf. I confirm that I will provide details of all my sources of income to the tax agent (My Tax Back Ltd). I understand that my agent (My Tax Back Ltd) is required to retain a copy of all documentation relating to any refund or credit or allowance or relief claimed by the agent on my behalf and that the agent (My Tax Back Ltd) will be required to produce same to Revenue upon request.