Form Cb 1 - Application Form For Child Benefit Page 5
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16Part 2
Habitual Residence condition
17.Are you employed or self-employed?
Yes
No
Please state:
If a Polish national, your
NIP number:
Name of country where
you work:
Name of country in which
you pay social insurance:
Name of employer:
Date you started your
current employment:
D D
M M
Y Y Y Y
If employed, please attach a letter from your employer, stating the date you started working,
your employer’s registered number and the class of social insurance paid.
18.If you have recently moved to the Republic of Ireland, when did you and your family move here?
You:
D D
M M
Y Y Y Y
Your spouse, civil partner
or cohabitant:
D D
M M
Y Y Y Y
Your children:
D D
M M
Y Y Y Y
19.What country were you
born in?
20.What is your nationality?
21.Have you lived in the Republic of Ireland continuously since the date you came to live here or
returned to live here?
Yes
No
22.Please give details of each country outside the Republic of Ireland that you have lived in.
Country 1
Country:
Dates you lived there:
From:
To:
D D
M M
Y Y Y Y
Last address there:
Why did you live there?
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