Application for a Refund of Motor Tax
| Published date | 19 July 2019 |
APPLICATION FOR A REFUND OF MOTOR TAX
RF120
Tax Disc must be surrendered immediately as refunds are generally calculated from the rst 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 DETAILS
1. REGISTRATION NUMBER
Make / Model Colour(s)
Chassis Number
OWNER
Mr., Ms., etc. First Name(s)
Surname OR Company Name
Address
Town / City
Country Phone No.
Eircode
B. REASONS FOR REFUND
1. Vehicle Stolen
The vehicle was stolen on
Day Month Year
and has not since been recovered
2. Vehicle Scrapped / Destroyed
The vehicle was scrapped
completely and destroyed on
and is incapable of being used
on the roads
3. Vehicle Exported
The vehicle was sent
permanently out of the State on
4. Vehicle Not Used
The vehicle has not been in a public place at any time
since the issue of the tax disc.
Documents to Accompany Application:
In all cases Tax Disc and Vehicle Licensing Certicate or
Registration (Log) Book
* `Medical certicate, letter from eductional body or business etc.,
conrming the relevant period.
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
*5. Vehicle not used because of Owner’s illness / injury
I, the owner of the vehicle have
ceased to use it from
because of illness, injury or other
physical disability and I will be unable
to use it until at least
*6. Vehicle unused because the Owner absent from the State
I, the owner of the vehicle have
ceased to use it from
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
*7. Vehicle Duty Error
The duty was paid / overpaid by mistake in the following
circumstances
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 Certicate, 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:
Serial Number of Application
Date of Surrender of Licence
Date of Expiry of Licence
Number of months remaining
Annual Rate of Tax
Repayment / Refund Amount
Date Allowed / Disallowed
Date Repaid / Refunded
Garda Station Stamp
C. DECLARATION
D. FO R O FF IC IA L US E ONLY
The completed form must be sent to your local Motor Tax Ofce
To continue reading
Request your trial