Form Cb 1 - Application Form For Child Benefit Page 13
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16Part 4 continued
Details of your qualified child(ren)
30.Do you have legal custody of your child(ren)?
Yes
No
31.Do you support your child(ren)?
Yes
No
For each child of school going age living in the Republic of Ireland, please attach a letter from
their school or college to confirm the date they started attending.
For each child not of school going age living in the Republic of Ireland, please attach a letter
from your doctor, the Gardaí, playschool or crèche to confirm that the child is normally living
in the Republic of Ireland.
Part 5
Your spouse’s, civil partner’s or cohabitant’s details
32.Their PPS No.:
33.Title: (insert an ‘X’ or
Mr.
Mrs.
Ms.
Other
specify)
34.Their surname:
35.Their first name(s):
36.Their birth surname:
37.Their Social Insurance Number or the equivalent, for example, National Insurance, Pesel,
CNP or ID Number:
38.If a Polish national, their
NIP number:
39.Their date of birth:
D D
M M
Y Y Y Y
40.Their address:
Answer this question only if
you do not live together.
41.Their nationality:
42.Are they getting Child Benefit?
Yes
No
If ‘Yes’, please state:
Reference number:
Last date of payment:
D D
M M
Y Y Y Y
Country that pays them:
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Parent category: Legal