Housing Benefit

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Application for Housing Benefit on privately owned dwellings which are not owned or leased by the Government, the Housing Authority, any parastatal body or local Authority. Section 1 - Personal Information about Applicant/s
Identity Card Number:*
Name:*
Surname:*
Date of Birth (DD/MM/YYYY) :*
Civil Status:*
Contact Number:
E-mail:

Identity Card Number:
Name:
Surname:
Date of Birth (DD/MM/YYYY) :
Civil Status:
Contact Number:
E-mail:

Identity Card Number:
Name:
Surname:
Date of Birth (DD/MM/YYYY) :
Civil Status:
Contact Number:
E-mail:
Details of Dwelling on which Housing Benefit is being requested
Address:*
Bank Account details where the subsidy is to be deposited Payment should be deposited in a Savings or Current Account. The indicated account has to be in the name of the beneficiary.
Bank Name:
IBAN:
Section 2 - Other Information
Amount of Rent per annum (€):
Applicant is requested to indicate whether he/she:
Has/have children under the age of 18 living with him/her:
If YES, how many:

How long is the rental agreement valid for? (DD/MM/YYYY) :

The property is a:

Date of marriage/Civil Union (in case of married couple/two persons who have entered into a Civil Union under the Civil Unions Act or separated/annulled/divorced) (DD/MM/YYYY) :

Date of death of spouse (in case of widows/ers) (DD/MM/YYYY) :

Name of spouse (in case of widows/ers) :
Section 3 - Necessary Documents (where applicable)
Photocopy of valid ID Card from both sides of each applicant and of children over the age of 18 living with them.
Attach:
Attach:
Attach:
In case of separated/annulled/divorced applicants, these are to produce a copy of the final judgement of the competent court that pronounces the separation or a copy of the contract of separation.
Attach:
In case of bone fide de facto separated persons, these are to produce proof and/or official documentation to substantiate this. It shall be discretionary on the Housing Authority to decide whether the documents submitted suffice the de facto separation.
Attach:
FS3 of applicants for calendar year preceding the date of application. In case of applicants in receipt of pensions, a document indicating the amount of pension received is to be produced. In case of self employed applicants, these are to produce a Profit & Loss Account/Income Statement signed by themselves and a Balance Sheet/Statement of Financial Position if applicable, together with Income Tax form for the year preceding the date of application if applicable.
Attach:
Copy of deed of rental agreement and latest rental receipt.
Attach:
In case of disabled children living with applicant, photocopy of valid Disability Card from both sides issued by the Commission for the Rights of Persons with Disability (CRPD).
Attach:

Attach:
In case of families having fostered children living with them, applicants who have lived in care, applicants who have successfully completed a rehabilitation programme or left CCF, a document specifying this should be produced.
Attach:
Section 4 - Declarations by Applicant/s
Declaration - Housing Benefit Scheme
Signed Declaration Form:*
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EmailAddress:
A non-refundable administrative fee of €10.00 applies upon submission of an application.