Signature of Owner:
Signature of Garda / Witness
Date:
Garda Station Stamp
APPLICATION FOR A REFUND OF MOTOR TAX
RF120
Tax Disc must be surrendered immediately as refunds are generally calculated from the first 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
Eircode
1. Vehicle Stolen
The vehicle was stolen on
B. REASONS FOR REFUND
*5. Vehicle not used because of Owner’s illness / injury
I, the owner of the vehicle have
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
Day Month Year
Day Month Year
ceased to use it from
because of illness, injury or other
physical disability and I will be unable
to use it until at least
Day Month Year
Day Month Year
3. Vehicle Exported
The vehicle was sent
permanently out of the State on
Day Month Year
*6. Vehicle unused because the Owner absent from the State
I, the owner of the vehicle have
ceased to use it from
4. Vehicle Not Used
The vehicle has not been in a public place at any time
since the
issue
of the tax disc.
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
Day Month Year
Day Month Year
Documents to Accompany Application:
In all cases Tax Disc and Vehicle Licensing Certificate or
Registration (Log) Book
* `Medical certificate, letter from eductional body or business etc.,
confirming the relevant period.
*7. Vehicle Duty Error
The duty was paid / overpaid by mistake in the following
circumstances
D. FOR OFFICIAL USE ONLY
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
The completed form must be sent to your local Motor Tax Office
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 Certificate, 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.
C. DECLARATION
Phone No.
PRIVACY STATEMENT
The Department of Transport requires customers to provide certain personal data in order to carry out our legislative
and administrative functions. The Department will treat all information and personal data that you provide as
confidential, in accordance with the General Data Protection Regulation and Data Protection legislation.
Your personal data may be exchanged with other Government Departments or agencies under the remit of Department
of Transport in accordance with law. Full details of the Department's data protection policy setting out how we will use
your personal data as well as information regarding your rights as a data subject are available at
www.gov.ie/en/publication/fdde77-data-protection/
Details of this policy are also available in hard copy upon request by
emailing dataprotection@transport.gov.ie or in writing to Data Protection Unit, Department of Transport, Leeson Lane,
Dublin D02
