Disability Allowance Application Form
3257324A
Your work and claim details
Part 2 continued
20(a). Are you taking part in any of the following courses or schemes, insert an X in the box
as it applies to you and give the date you started if you insert an X in the Yes box.
Community employment: Yes
No
D D MM Y Y Y Y
Date you started:
Rural Social Scheme: Yes
No
D D MM Y Y Y Y
Area-Based Initiative: Yes No
D D MM Y Y Y Y
Back to Work Scheme: Yes No
D D MM Y Y Y Y
Vocational Training
Opportunities Scheme:
Yes
No
D D MM Y Y Y Y
Back to Education
Allowance:
Yes
No
D D MM Y Y Y Y
FÁS course or schemes: Yes No
D D MM Y Y Y Y
School or college: Yes No
D D MM Y Y Y Y
Other course or scheme: Yes No
If ‘Yes’, please state:
Name of course or scheme:
Date you started: From:
To:
D D MM Y Y Y Y
Page 4
20(b). Please state what you get paid for doing this scheme or course:
a week
€ , .
21.Do you own stocks, shares (including shares in a creamery or Co-op, annuities, bonds,
insurance policies) or investments in the Republic of Ireland or another country?
Their value:
Please attach a statement to show details and current market value.
Yes
No
If ‘Yes’, please state:
€ .,
Name of company:
Number of shares held:
,
03215C2D
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