Document text
Phased Payment Arrangement with Revenue: preparation sheet
Name: [NAME] · PPSN: [PPSN] · Tax: [INCOME TAX / FORM 11 BALANCE, OTHER]
1. Can I apply?
[ ] Total debt, including interest and penalties, is more than €500: [AMOUNT]
[ ] All tax returns due to Revenue are filed (Form 11 for [YEAR] filed on [DATE])
[ ] I do not have an existing Phased Payment Arrangement
[ ] I can pay my current taxes as they fall due
2. What I will propose
Item My figure
Total debt [AMOUNT]
Down-payment I can make now [AMOUNT]
Repayment period [NUMBER] months
Monthly instalment [AMOUNT]
Preferred repayment date [DAY OF THE MONTH]
Bank account for direct debit [BANK, IBAN LAST 4 DIGITS]
3. Six-month cash flow (Revenue may ask for it)
Month Money in Money out Left for tax
[MONTH 1] [AMOUNT] [AMOUNT] [AMOUNT]
[MONTH 2] [AMOUNT] [AMOUNT] [AMOUNT]
[MONTH 3] [AMOUNT] [AMOUNT] [AMOUNT]
[MONTH 4] [AMOUNT] [AMOUNT] [AMOUNT]
[MONTH 5] [AMOUNT] [AMOUNT] [AMOUNT]
[MONTH 6] [AMOUNT] [AMOUNT] [AMOUNT]
4. Apply and follow up
[ ] Applied in ROS with the ePPA1 form on [DATE]
[ ] Bank statements ready, if asked
[ ] Revenue reply expected within ten days: by [DATE]
[ ] Extra information requested? Replied on [DATE] (if not answered in time, the application is cancelled)