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1. I authorise Mrs. Eva Kornecka to act as my agent and represent me with the Revenue Commissioners and the Department of Socia !rotection for the current ta" year# the four preceding ta" years and the fo owing ta" years unti this authorisation is ceased $y either c ient or agent. %. I authorise Mrs. Eva Kornecka to receive a communication from the Revenue commissioners and the Deparment of Socia and fami y &ffairs# Ire and on my $eha f in respect of these ta" years. '. I agree to a ow Mrs. Eva Kornecka to process any income ta" refund due to me. (. I authorise Mrs. Eva Kornecka to receive my ta" refund from the Revenue Commissioners and the Department of Socia !rotection on my $eha f. ). *here the Refund che+ue is received $y Mrs. Eva Kornecka# I authorise Mrs. Eva Kornecka to endorse and odge the che+ue# deduct commission and fees at the agreed rate and remit the remaining amount to myse f $y the agreed method. ,he payment wi $e made within ' working days of receipt of my payment detai s.. -. *here I receive the fu refund che+ue or refund $y $ank transfer into my $ank account from the revenue Commissioners or ,he Department of Socia !rotection I agree to send the agreed commission and fees to Mrs. Eva Kornecka within . days since the day I have received it. .. /n ess otherwise agreed# I agree a commission rate of 1%0 of any refunds received 1 2) for each ta" year where any refund has $een made su$3ect to a minimum fee of 2'). If the refund is 245() then no fee is paid. ,he same ru es are for !RSI refund and Income 6evy refund. 7. If you re+uire document retrieva services for your Irish ta" refund# our fee for this is 21) per document 8I ness 9enefit statement# :o$seekers 9enefit statement# !-4# !()...; <. I understand that the Irish ,a" &uthorities wi make the fina decision on the va ue of any refund due or any $a ance due to them $y me and that any estimation given $y Mrs. Eva Kornecka# is an estimation# not a guarantee. 14. I have provided true# accurate and comp ete information regarding my income# ta"es# and persona circumstances to Mrs. Eva Kornecka. 11. I commit that I ho d receipts and documents and I understand that I may need to provide them at a future date to the Revenue Commissioners to support my c aim. 1%. I wi keep Mrs. Eva Kornecka up to date with any changes in my contact or persona detai s. 1'. I understand that my ,a" agent wi protect my persona information as per the re evant data protection egis ation. =>,ES? Customer =ame in !rint Customer Signature Date? @@@@@@@@@@ @@@@@@@@@@ @@@.A@@@A@@@.

Eva Kornecka Registered ,a" &dvisor

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