Bike To Work Scheme

Information required for the Sample Application form

This is a sample application form that you might want to adapt for internal use within your company to keep a record of employees who avail of the scheme. Please note that there is no requirement to notify Revenue that you are availing of the scheme but the purchase of bicycles and associated equipment by employers for directors and employees will be subject to the normal Revenue audit procedure with the normal obligations on employers to maintain records (e.g. delivery dockets, invoices, payments details, salary sacrifice agreements between employer and employee, signed statements from employees that the bicycle/bicycle safety equipment is for own use and will be used for traveling to and from work).

If you have any specific questions relating to the taxation elements of the scheme to which you can’t find answers on our website  please contact  the Revenue Commissioners’ Employer Information and Customer Service Unit on 1890 25 45 65




Sample Application form


Employee Name: ............................................................................

Department:.......................................................................................

Staff number: .................................................................................

Phone Contact:..........................................................................

Bicycle model / record number:............................................

Amount: ...................................................................................






Signed statement regarding use of the bicycle

I _________________, declare that the bicycle to be purchased by my employer on my behalf as part of the Government tax incentive scheme* is for my own personal use and will be used mainly for the purposes of qualifying journeys, where qualifying journeys are defined as the whole or part (e.g. between home and train station) of a journey between employee’s or director’s home and normal place of work, or between his or her normal place of work and another place of work.

*as defined in section 7 of the Finance (NO. 2) Act 2008



(If relevant….


Salary sacrifice agreement

Please alter the terms and conditions of my contract to forego € _____ of my annual salary for the purchase of a bicycle and related equipment. I understand that the cost of the bicycle and related equipment will be deducted from my gross salary.)

 

 

Signed:-  ........................................................

Date:...............................................................