District No.

*Dublin Metropolitan District

of ………..

Who says on oath-

I am an authorised officer of the Revenue Commissioners. I make this application with the consent in writing of a Revenue Commissioner.

I believe that there are reasonable grounds for suspecting that an offence (falling within the provisions of the Acts as defined by section 908A of the Taxes Consolidation Act 1997 as amended by section 132 of the Finance Act 2002) which would result (or but for its detection would have resulted) in serious prejudice to the proper assessment and collection of tax, is being, has been or is or was about to be committed *(in the said district) (having regard to the amount of a liability in relation to any person which might be, or might have been, evaded but for the detection of the relevant facts) and that there is material in the possession of … a financial institution, at …….*(in the said district) which is likely to be of substantial value (whether by itself or together with other material) to the investigation of the relevant facts.

The basis for my so believing is as follows:-

And I hereby apply for an order under the provisions of section 908A of the Taxes Consolidation Act 1997, as inserted by section 207 of the Finance Act 1999 and as amended by section 68 of the Finance Act 2000, by section 132 of the Finance Act 2002 and by section 88 of the Finance Act 2004 that I, the applicant, be authorised to inspect and take copies of any entries in the books, records or other documents of the said ……… a financial institution, and any documentation associated with or relating to an entry in such books, records or other documents at ….. *(within said district) for the purposes of investigation of the relevant facts.

Signed ………….

Informant

SWORN before me this ... day of ..... 20...

Signed ……………….

Judge of the District Court

*Delete inapplicable words