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Social Welfare Services Application form for AGENT ...
assets.gov.ieApplication form for Authority to Appoint an Agent (other than HSE) 5. Address: • Please use BLACK ballpoint pen. • Please use BLOCK LETTERS. • Please answer all questions that apply to you. 6. Telephone number: 7. Email address: 8. Name of Social Welfare allowance or pension in payment: 4. Date of birth: D D M M Y Y Y Y 9.