Application Form for Fuel Allowance under the National Fuel Scheme
Application form for
Fuel Allowance under the
National Fuel Scheme
NFS 1
Social Welfare Services
Part 1
Your own details
1. Your PPS No.:
3. Surname:
8. Your date of birth:
4. First name(s):
Mr. Mrs. Ms.
Other
2.
Title: (insert an ‘X’ or
specify)
6. Birth surname:
5. Y
our first name as it
appears on your birth
certificate
:
I declare that all the information I have given on this form is accurate.
I will tell the Department when my means or circumstances change.
Signature (not block letters)
Date:
D D M M Y Y Y Y
2 0
10.Y
our telephone number:
L A N D L I N E
M O B I L E
11.Your email address:
9. Your address:
Declaration
7. Your mother’s birth
surname:
D D M M Y Y Y Y
Contact Details
Warning: If you make a false statement or withhold information, you may be
prosecuted leading to a fine, a prison term or both.
Page 3/8
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