Disability Allowance Application Form
261BAD02
Your work and claim details
Part 2 continued
23.Do you own or share in the ownership of property apart from your home?
Type of property:
Address of property:
‘Property’ would be an
apartment, business
property, another house or
land other than that
mentioned at question 19.
€ , .,
Current market value:
Yes
No
If ‘Yes’, please state:
a week
€ , .
Rent from this
property:
Please provide a valuation from an authorised auctioneer or valuer.
Outstanding
mortgage on
property:
If mortgaged please attach a recent statement from lending institution.
Note: A separate sheet of paper can be used for details of any additional properties that you have.
€ , .,
24.Are you receiving
maintenance?
Amount:
Yes
No
If ‘Yes’, please state:
a week
€ , .
Please provide a copy of the maintenance agreement.
25(a). Have you made or do you intend to make a claim for compensation?
Yes No
If ‘Yes’, please give details in the space provided:
If you are receiving maintenance, please state the amount of mortgage or rent that you pay a week:
Amount: a week
€ , .
Please attach a statement from body, agency or rent receipt from
your landlord.
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