O. 34A, r 2(3)

*I AM SATISFIED THAT

An operation or investigation is being conducted by the Revenue Commissioners concerning a revenue offence *contrary to *under

* section 186 of the Customs Consolidation Act 1876

* section 1078 of the Taxes Consolidation Act 1997

* section 102 of the Finance Act 1999

* section 119 of the Finance Act 2001

* section 79 (inserted by section 62 of the Finance Act 2005) of the Finance Act 2003

* section 78 of the Finance Act 2005 being the revenue offence of ...............

AND I AM SATISFIED THAT as part of that operation or investigation being conducted as aforesaid the surveillance authorised hereby is necessary for the purpose of * obtaining information as to whether the offence has been committed * obtaining information as to the circumstances relating to the commission of the offence * obtaining evidence for the purposes of proceedings in relation to the offence

*I AM SATISFIED THAT the surveillance authorised hereby is necessary for the purposes of preventing the commission of revenue offences.

I AM SATISFIED THAT the surveillance authorised hereby is

(a) the least intrusive means available, having regard to its objectives and other relevant considerations,

(b) proportionate to its objectives, having regard to all the circumstances including its likely impact on the rights of any person, and

(c) of a duration that is reasonably required to achieve its objectives

I AM SATISFIED THAT the surveillance authorised herein is not likely to relate primarily to communications protected by privilege.

I AM SATISFIED THAT it is reasonable in the circumstances that this Authorisation shall expire on the ..... day of .......... 20 ...

*The said Superior Officer approved the carrying out of surveillance in accordance with subsection (3) of section 7 of the Act and has applied under subsection (4) of section 4 of the Act for said surveillance to be continued and having regard to a copy of the written record of approval under subsection (3) of section 7 of the Act, and to the summary of the results of the surveillance carried out pursuant to that approval produced with said application

I HEREBY ISSUE AN AUTHORISATION under section 5 of the Act for the carrying out of surveillance

(a) by the use of a surveillance device the particulars of the same being

........................

(b) *The person who is to be the subject of the surveillance being

........................

*The place to be the subject of the surveillance being

........................

*The thing to be the subject of the surveillance being

........................

(c) the Superior Officer to whom this Authorisation is issued being the said Superior Officer named above

*(d) The conditions imposed in respect of the surveillance authorised are

........................

as I consider appropriate

(e) The date of expiry of the surveillance being the ..... day of .......... 20.... which date of expiry I consider reasonable in the circumstances, being not later than three months from the date hereof.

*AND WHEREAS I AM SATISFIED THAT there are reasonable grounds for believing that, for the purposes of the Authorisation sought, it will be necessary for an officer of the Revenue Commissioners to enter, if necessary by the use of reasonable force, a place, namely .............., for the purposes of initiating or carrying out the surveillance to be authorised, and withdrawing the authorised surveillance device, without the consent of a person who owns or is in charge of the said place.

*AND THIS AUTHORISATION FURTHER AUTHORISES:

*................. of ............... the Superior Officer

*.................. of .............. an officer of the Revenue Commissioners designated by ...................... of .................. , the Superior Officer, accompanied by any other person whom he/she considers necessary, to enter, if necessary by the use of reasonable force, a place namely, ..............................., for the purpose of initiating or carrying out the authorised surveillance, and withdrawing the authorised surveillance device, without the consent of a person who owns or is in charge of the place.

Issued this ..... day of ........... 20....

......................

Judge of the District Court

To the said Superior Officer,

.............................

of ..........................

* Delete any words or paragraphs which are inapplicable