Form Cb 1 - Application Form For Child Benefit Page 11
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16Part 4 continued
Details of your qualified child(ren)
Child 3
Their surname:
Their first name(s):
Are they:
Male
Female
Their date of birth:
D D
M M
Y Y Y Y
Their nationality:
How is the child related to
you?
Is this child living with you
Yes
No
in the Republic of Ireland?
If ‘No’, what country do
they live in?
Date they came to live with
you:
D D
M M
Y Y Y Y
Their Social Insurance Number or the equivalent, for example, National Insurance, Pesel, CNP or
ID Number:
Child 4
Their surname:
Their first name(s):
Are they:
Male
Female
Their date of birth:
D D
M M
Y Y Y Y
Their nationality:
How is the child related to
you?
Is this child living with you
Yes
No
in the Republic of Ireland?
If ‘No’, what country do
they live in?
Date they came to live with
you:
D D
M M
Y Y Y Y
Their Social Insurance Number or the equivalent, for example, National Insurance, Pesel, CNP or
ID Number:
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