You need a Personal Public Service Number (PPS No.) before you apply.
How to complete this application form.
• Please tear off this page and use as a guide to filling in this form.
• Please use BLACK ball point pen.
• Please use BLOCK LETTERS and place an X in the relevant boxes.
• Please answer all questions. We will return any form that is incomplete. This
will delay your application for Supplementary Welfare Allowance.
If you do not have a spouse, civil partner or cohabitant:
Fill in Parts 1, 3, 4, 7, 8 and 9 as they apply to you. When form is completed,
read Part 10 and sign declaration in Part 1.
If you have a spouse, civil partner or cohabitant:
Fill in Parts 1, 3, 4, 5, 7, 8, and 9 as they apply to you and your spouse, civil
partner or cohabitant. When form is completed, read Part 10 and sign
declaration in Part 1.
If you are an employer for the applicant fill in Part 2. If you are an employer
for the spouse, civil partner or cohabitant fill in Part 6. Please make sure you
sign and stamp these parts of the form.
Landlord or landlord’s agent:
Please fill in Part 11. Please make sure you sign and stamp this part of the form.
To process your Rent Supplement, we need to establish ownership of the
property by the landlord. One of the following documents are acceptable in
1. Evidence of registration with Private Residential Tenancies Board (PRTB).
2. Receipt from Non Principal Private Residence (NPPR).
3. Evidence of buildings insurance policy held by landlord.
If you need any help to complete this form, please contact your local Intreo
Centre, Social Welfare Office or Citizens Information Centre.
For more information, log on to www.welfare.ie.
SWA RS 1
Social Welfare Services
Data Classification R
Application form for
Supplementary Welfare Allowance