Disability Allowance Form Page 7
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36362B1194
Part 2 continued
Your work and claim details
22.Do you have savings or accounts in a bank, post office, building society, credit union or any
other financial institution in the Republic of Ireland or another country?
Yes
No
If ‘Yes’, please state:
Financial Institution 1
Name of financial institution:
Bank Identifier Code (BIC):
International Bank
Account Number (IBAN):
€
.
Current balance:
Is this account a joint
Yes
No
account?
Name(s) of account holder(s):
Name 1:
Name 2 (if any):
Financial Institution 2
Name of financial institution:
Bank Identifier Code (BIC):
International Bank
Account Number (IBAN):
€
.
Current balance:
Is this account a joint
Yes
No
account?
Name(s) of account holder(s):
Name 1:
Name 2 (if any):
Please attach an original statement for each account, showing transactions for the last 6
months.
If you have any other accounts you must give details of them to this Department on a
separate sheet of paper.
Page 5
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