Form Cb 1 - Application Form For Child Benefit Page 16
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16Department use only
HRC satisfied
HRC not satisfied
HRC1 issued
I award payment of Child Benefit to the children named in Part 4.
I disallow payment of Child Benefit to the children named in Part 4.
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With effect from:
M M
Y Y Y Y
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Date:
D D
M M
Y Y Y Y
Deciding officers signature (not block letters)
Send this completed application form to:
Child Benefit Section
Social Welfare Services
Department of Social Protection
St. Oliver Plunkett Road
Letterkenny
Co. Donegal
Telephone:
(074) 916 4496
LoCall:
1890 400 400
If you are calling from outside the Republic of Ireland please call + 353 74 916 4496
Note: The rates charged for the use of 1890 (LoCall) numbers may vary among different service providers.
Data Protection Statement
The Department of Social Protection will treat all information and personal data you give us as
confidential. However, it should be noted that information may be exchanged with other
Government Departments / Agencies in accordance with the law.
Explanations and terms used in this form are intended as a guide only and are not a legal interpretation.
65K 08-15
Edition: August 2015
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Parent category: Legal