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Application form for Social Welfare Services …

You need a Personal Public Service Number (PPS No.) before you you have qualified children and don t qualify for a Widow s, Widower s or Surviving Civil Partner s Contributory Pension you should apply for a One-Parent Family Payment to complete this Application form . Please use this page as a guide to filling in this form . Please answer all questions. Incomplete forms will be returned and this may delay your Application . Please use blaCkball point pen. Please use BLOCK LETTERS and place an X in the relevant in all Parts as they apply to you.

Part 2 continued Your work and claim details 19.Are you getting a social security payment from another country? Name of country: Your claim or reference

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