District No.

*Dublin Metropolitan District

of

UPON HEARING an application made to me on this date by the above-named Applicant, an authorised officer of the Revenue Commissioners 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

AND BEING SATISFIED 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;

IT IS HEREBY ORDERED pursuant to the said 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 the applicant be authorised to inspect and take copies of any entries in books, records or other documents of …….. and any documentation associated with or relating to an entry in such books, records or other documents, for the purposes of investigation of the relevant facts.

Dated this … day of ……… 20…

………………….

Judge of the District Court

*Delete inapplicable words