The declaration referred to in section 256(1B) is a declaration in writing to the Revenue Commissioners which -

(a) is made by the person (in this section referred to as the 'declarer') to whom any interest on the deposit in respect of which the declaration is made is payable by the relevant deposit taker and is signed by the declarer,

(b) is made in such form as may be prescribed, authorised or approved by the Revenue Commissioners,

(c) declares that at the time when the declaration is made -

(i)

(I) the individual beneficially entitled to the interest in relation to the deposit or his or her spouse or civil partner is permanently incapacitated by reason of mental or physical infirmity from maintaining himself or herself, and

(II) the individual beneficially entitled to any interest paid in respect of that deposit in any year of assessment or his or her spouse or civil partner, is a relevant person (within the meaning of section 267) and the individual would, in accordance with section 267(3), be entitled to repayment of the whole of any appropriate tax if it had been deducted from that interest,

or

(ii)