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Claim for Tax Relief in Respect of Tuition Fees for Third Level Education

Name of Claimant PPS Number Name of student (if different) Name and address of the person who paid the fees

Course Title Duration of Course Amount of Tuition fees paid Academic year to which claim refers Tick () the appropriate box. (YYYY/YYYY) Full-Time , .

/
Part-Time

Is the course

In the case of a post graduate course, please confirm if the student has been conferred with an undergraduate degree: Yes No

Has any part of the tuition fees been or will they be met directly or indirectly by: A grant A scholarship An employer Otherwise Yes Yes Yes Yes No No No No Amount Amount Amount Amount , , , , . . . .

Declaration which must be signed.

I declare that all the information given by me on this form is correct to the best of my knowledge and belief. Signature Date Telephone Number Email address

IT31

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