The declaration, referred to in section 848W, is a declaration in writing made by an individual to an administrator which -
(a) is made and signed by the 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 848AF,
(c) contains the individual's -
(i) name,
(ii) address of his or her permanent residence,
(iv) date of birth, and
(v) amount of pension subscription,
and
(d) declares that -
(i) the individual's gross income, for the year of assessment immediately before the year of assessment in which the maturity date of his or her special savings incentive account falls, does not exceed €50,000,
(ii) none of the individual's taxable income for the previous year is chargeable to tax at the higher rate, or in the case of an individual who is married, none of the individual's taxable income for that year would be so chargeab
…