The declaration referred to in section 848N(2)(b) is a declaration in writing made by the qualifying individual to the qualifying savings manager who is the transferee referred to in that section, which -
(a) is made and signed by the qualifying individual,
(b) is made in such form -
(i) as may be prescribed or authorised by the Revenue Commissioners, and
(ii) which contains a reference to the offence of making a false declaration under section 848T.
(c) contains the qualifying individual's -
(i) name,
(ii) address of his or her permanent residence,
(iii) PPS Number, and
(iv) date of birth,
and
(d) declares -
(i) at the time the declaration is made, that the qualifying individual -
(I) has not commenced another special savings incentive account, and
(II) is the person who beneficially owns the qualifying assets held in the account being transferred,
(ii) at the time the special savings incentive account was commenced, the qualifying individual was resident in the State,
(iii) that subs
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