Carers Allowance Form Sample
You need a Personal Public Service Number (PPS No.) before you apply.
How to complete this application form.
• Please use this page 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 that apply to you.
• Please do not strikethrough any of the boxes. Leave boxes blank if they do not
apply to you.
You should apply for Carer’s Allowance as soon as you start caring for someone.
If you do not have a spouse, civil partner or cohabitant
:
If you do not have a spouse, civil partner or cohabitant, fill in Parts 1 to 5 and
Part 8. When the form is completed, read Part 9 and sign declaration in Part 1.
If you have a spouse, civil partner or cohabitant
:
If you have a spouse, civil partner or cohabitant, fill in Parts 1 to 8.
When the form is completed, read Part 9 and sign declaration in Part 1.
carer
:
Please complete Section a in Part 10 of the medical report and get the person
you are caring for to sign Section a in Part 10 of the medical report.
Doctor
:
Please fill in Section b in Part 10 of the medical report. Please make sure you
sign and stamp this part of the form.
If you need any help to complete this form, please contact your local Citizens
Information Centre, your local Intreo Centre or your local Social Welfare Office.
For more information, log on to www.welfare.ie.
Application form for
Carer’s Allowance
CR 1
Social Welfare Services
Data Classification R
Page 1/32
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Carers Allowance Form Sample PDF
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