Fillable Printable Application Form for Fuel Allowance under the National Fuel Scheme
Fillable Printable Application Form for Fuel Allowance under the National Fuel Scheme
Application Form for Fuel Allowance under the National Fuel Scheme
How to complete application form for Fuel Allowance under the National Fuel
Scheme.
• 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. If a question does not apply to
you, please leave the answer area blank.
• You need a Personal Public Service Number (PPS No.) before you apply.
Applicant:
Please fill in all parts as they apply to you. When form is completed, sign
declaration in Part 1.
If you need any help to complete this form, please contact your local Social
Welfare Office or Citizens Information Centre.
For more information, log on to www.welfare.ie.
NFS 1
Social Welfare Services
Application form for
Fuel Allowance under the
National Fuel Scheme
How to fill in first page of this form
To help us in processing your application:
• Print letters and numbers clearly.
• Use one box for each character (letter or number).
Please see example below.
SAMPLE
1 2 3 4 5 6 7 T
M U R P H Y
M A U R
E E N
M C D E R M O T T
1 N E W S T R E E T
O L D T O W N
C O D O N E G A L
L A N D L I N E
M O B I L E
0 1 7 0 4 3 0 0 0
0 8 6 1 2 3 4 5 6 7
2 8 0 2 1 9 7 0
M M U R P H Y @ W E L F A R E . I E
1. Your PPS No.:
3. Surname:
8. Your date of birth:
4. First name(s):
D D M M Y Y Y Y
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
:
10.Y
our telephone number:
11.Your email address:
Contact Details
9. Your address:
X
M A R Y
7. Your mother’s birth
surname:
K E L L
Y
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.
Part 1 continued Your own details
13.Are you getting a payment from this Department?
Yes
No
14.If ‘Yes’, please state name of payment:
19.If you have savings in a financial institution, please state:
20.If you own property, other than your home, please state:
Market value of
property:
Amount of savings:
16.If you are employed or self-employed, please state:
18.If you own stocks, shares or investments, please state:
Gross income:
a week
Their value:
17.If you have income from any source such as an occupational pension and including any
pension from another country, please state:
Gross income:
21.If this property is rented out, please state:
Rental income:
€
a week
€
a week
€
€
, .,
, .
, .
, .
22.If you have a business, please state:
Yearly profit:
€
, .,
12.Are you?
Single
Widowed Remarried
Married Cohabiting
Divorced
Separated
Your claim and income details Part 2
15.If you are getting a pension or allowance from another country, please state:
Name of country:
Claim or reference number:
Name of payment:
How long have you been
getting this payment?
months
€
, .,
€
, .,
Your payment detailsPart 3
If you are already getting a payment from this Department, your Fuel Allowance will be paid
with your current payment. If you are not already getting a payment from this Department, you
can get payment at your local post office or direct to your current, deposit or savings account in
a financial institution. Please complete either option below if you are not already getting a
payment from this Department.
Post Office
Financial Institution
Name of financial institution:
Sort code:
Account number:
Post Office address:
Bank Identifier Code (BIC):
International Bank Account
Number (IBAN):
You will get the following details printed on statements from your
financial institution.
Name(s) of account holder(s):
Name 1:
Name 2 (if any):
Part 4 Your spouse’s or partner’s details
23.
PPS No.:
25.S
urname:
26.F
irst name(s):
24.T
itle: (insert an ‘X’ or
specify)
27.Birth surname
:
Mr. Mrs. Ms.
Other
29.Gross weekly income:
32.Rent from this
property: (other than
family home)
31.Value of property:
(other than family
home)
30.Total savings/
investments:
33.Profit from business:
a week
a year
€
€
, .,
€
€
, .
, .
.,
This includes all earnings and pensions, if any.
28.
Address:
Only answer this question
if you do not live together.
€
, .,
Part 5 Household details
Person 1
PPS No.:
Name:
Gross weekly income:
Rent from this
property: (other than
family home)
Value of property:
(other than family
home)
Total savings/
investments:
Profit from business:
a week
a year
€
€
,
.
,
€
€
,
.
, .
.,
This includes all earnings and pensions, if any.
Person 2
PPS No.:
Name:
Gross weekly income:
Rent from this
property: (other than
family home)
Value of property:
(other than family
home)
Total savings/
investments:
Profit from business:
a week
a year
€
€
,
.
,
€
€
,
.
, .
.,
This includes all earnings and pensions, if any.
34.List all people living with you and give the following information for each.
€
, .,
€
,
.
,
Send this completed application form to:
Send this completed application form to the section of the Department of Social Protection that
pay you.
If you are receiving a payment from another country, you should send your application form to:
NFS Section
Social Welfare Services
College Road
Sligo
60K 03-11 Edition: October 2010
Data Protection and Freedom of Information
We, the Department of Social Protection, will treat all information and personal data you give
as confidential. We will only disclose it to other people or bodies according to the law.
Explanations and terms used in this form are intended as a guide only and are not a legal interpretation.
Person 3
PPS No.:
Name:
Gross weekly income:
Rent from this
property: (other than
family home)
Value of property:
(other than family
home)
Total savings/
investments:
Profit from business:
a week
a year
€
€
, .,
€
€
, .
,
.
.,
This includes all earnings and pensions, if any.
35.If you need constant care and attention please state name of person providing this:
Surname:
First name(s):
Their PPS No.:
A Social Welfare Inspector may call on you to examine your application and may ask to see
documents about your household means.
Part 5 continued
Household details
€
, .,
