Social Welfare Services

Application form for CB 1

Child Benefit
Data Classification R

What is Child Benefit?

Child Benefit is a monthly payment to support parents and guardians. It is paid for each child who:
• normally lives with you and is being fully supported by you; and
• is under 16, or under 18 if in full-time education, full-time training or has a disability and cannot
support themselves.
Child Benefit is not paid on behalf of children 18 or older, even if they stay in education or training.
How do I qualify?
To qualify for Child Benefit, you must meet the habitual residence condition. This applies to all
applicants regardless of nationality.
Child Benefit is normally paid to the child’s mother or step-mother. If the child does not live with their
mother or step-mother but lives with their father or step-father, Child Benefit can be paid to them. If
the child is not living with or being maintained by their parents, the person caring for the child may
get Child Benefit.
How do I apply?
If your baby is born in Ireland and you are not already claiming Child Benefit for any other children,
the Child Benefit Section will automatically send you a claim form to complete when you register the
birth of your child. This form also includes information on how to claim for your new baby online at
www.MyWelfare.ie
If you are already getting Child Benefit, your new baby is added to your Child Benefit claim when
you register their birth and payment begins automatically from the month after the birth.
If your child is not born in Ireland, or their birth is not registered within the required time of three
months, you must fill in Child Benefit form (CB1) and send it to the Child Benefit Section as you
cannot apply online. A CB2 application form must also be filled out for each child aged 16 or 17
years, available from www.gov.ie/CB2
How to complete this application form?
There are examples on the back of this page that can be used as a guide to fill in this form. Please:
• write with a black ballpoint pen, use capital letters and place an X in the relevant boxes; and
• complete all parts relevent to you and sign the declaration in Part 9.
Where to send this form?
Child Benefit Section
Department of Social Protection
St. Oliver Plunkett Road
Letterkenny
Co. Donegal
F92 T449
How can I get help and further information?
If you need any help to complete this form, contact the Child Benefit section on 0818 300 600 or
074 916 4496 if calling from outside of ireland. You can also contact your local Intreo Centre or
Social Welfare Office, details available by visiting www.gov.ie/intreocentres, or any Citizen’s
Information Centre. For more information on Child Benefit, visit www.gov.ie/CB
 How to fill in this form
To help us in processing your application, write letters and numbers clearly and use one box
for each. Please see examples below.

Part 1 Your details

1. Your PPS Number: 1 2 3 4 5 6 7 T

2. Title, insert an X or Mr Mrs X Ms Other

specify:

3. Surname: M U R P H Y

4. First names: M A U R E E N

M A R Y

5. Your birth surname: M C D E R M O T T

6. Your mother’s birth

surname: W A L S H

7. Your date of birth: 2 8 0 2 1 9 7 0

D D M M Y Y Y Y

8. Your address: 1 N E W S T R E E T
O L D T O W N

D O N E G A L T O W N

County D O N E G A L Eircode C 1 5 A 9 6 V

9. Your telephone number: 0 8 8 1 2 3 4 5 6 7

10. Your email address: M M U R P H Y @ W E L F A R E . I E

SAMPLE
 Social Welfare Services

Application form for CB 1

Child Benefit
Data Classification R

Part 1 Your details

1. Your PPS Number:

2. Title, insert an X or Mr Mrs Ms Other

specify:

3. Surname:

4. First names:

5. Your birth surname:

6. Your mother’s birth

surname:

7. Your date of birth:

D D M M Y Y Y Y

8. Your address:

County Eircode

9. Your telephone number:

10. Your email address:

11. Are you? Single Cohabiting

Married In a Civil Partnership
Separated A surviving Civil Partner
Divorced A former Civil Partner

Widowed (you were in a Civil Partnership

that has since been dissolved)

Page 1
Part 1 continued Your details
12. If you are:

Married or entered into a civil partnership, from what date?

D D M M Y Y Y Y

A cohabiting couple, from what date?

D D M M Y Y Y Y

Separated, divorced or your civil partnership is dissolved,

from what date?
D D M M Y Y Y Y

13. Are or were you getting Child Benefit? Yes No

If yes, please state:

Reference number:

Last date of payment:

D D M M Y Y Y Y

Country that pays you:

14. Do you have a Social Insurance Number or the

equivalent, for example, National Insurance, Pesel, CNP Yes No
or ID Number?

If yes, please state:

Number:

15. Are you getting any other social protection benefit or pension? Yes No

If yes, please state:

Country that pays you:

Name of benefit or
pension:

Reference number:

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Part 2 Habitual residence condition

The habitual residence condition means that you have a proven close link to Ireland. The term also
conveys permanence - that a person has been here for some time and intends to stay here for the
foreseeable future.

Habitual residence in Ireland is a condition that you must satisfy for certain social protection
payments including Child Benefit.

16. Are you employed? Yes No

If yes, please state:

Your National Insurance

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

17. Are you self-employed? Yes No

If yes, please state:

Your National Insurance

number:
Name of country where
you work:

Name of country in which

you pay social insurance:

Name of business:

Date you started your

current employment:
D D M M Y Y Y Y

18. What country were you

born in?

19. What is your nationality?

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Part 2 continued Habitual residence condition
20. If you have recently moved to the State, 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

21. Have you lived in the State continuously since the date
you came to live here or returned to live here? Yes No

22. Please give details of each country, starting with the most recent, outside of the State that you
have lived in:

Country 1
Country:

Date from:

Date to:
D D M M Y Y Y Y

Last address there:

Country 2
Country:

Date from:

Date to:
D D M M Y Y Y Y

Last address there:

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Part 2 continued Habitual residence condition
Country 3
Country:

Date from:

Date to:
D D M M Y Y Y Y

Last address there:

Note: A separate sheet of paper can be used for more details if needed.

23. Have you lived at the same address for the last 2 years? Yes No

If no, please state:

Last address:

From:
Dates you lived there:
To:
D D M M Y Y Y Y

24. Do you have a current Irish Residence Permit (IRP)? Yes No

If yes, please state:

Your IRP Number:

If no, have you ever made an application for refugee status or

Yes No
leave to remain in the State?

If yes, are you awaiting a decision on your application? Yes No

If yes, please provide verified copies of all relevant documentation from the Department of Justice.
Please do not post the original documents, as the Department of Justice advise that you must keep
the originals with you at all times. To verify, please bring these original certificate copies to any office
of the Department of Social Protection.

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Part 3 Payment details

You can get your payment at a post office of your choice or direct to your current, deposit or
savings account in a financial institution. Please complete one option below.

Post Office

Please enter below the name and address of the post office where you wish to collect your payment.

Post office name and

address:

County Eircode

Financial Institution
You will find the following details printed on statements from your financial institution.

Name of financial
institution:

Bank Identifier Code

(BIC):

International Bank
Account Number (IBAN):

Currency of the account:

Names of account holders:

Name 1:

Name 2, if any:

An Post Childcare Savings Account

Account number:

If you do not have an account and wish to open a childcare savings account with An Post, application
forms are available from any post office.

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Part 4 Details of your children
25. Please give details of children who normally live with you and are being supported by you.

Notes:
• If your child is residing in Ireland you should apply for a Personal Public Service (PPS)
Number for your child before applying for Child Benefit.
• Provide evidence of residency in the State for each child. See checklist in Part 8 for details of
evidence.

Child 1
Their surname:

Their first names:

Their date of birth:

D D M M Y Y Y Y
Their nationality:

How is the child related

to you?

Is this child living with you? Yes No

If yes, the date they
came here:
D D M M Y Y Y Y
If no, what country do
they live in?

What is their PPS Number or the equivalent, for example, National Insurance Number, Pesel,
CNP or ID Number?

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Part 4 continued Details of your children
Child 2
Their surname:

Their first names:

Their date of birth:

D D M M Y Y Y Y
Their nationality:

How is the child related

to you?

Is this child living with you? Yes No

If yes, the date they
came here:
D D M M Y Y Y Y
If no, what country do
they live in?

What is their PPS Number or the equivalent, for example, National Insurance Number, Pesel,
CNP or ID Number?

Child 3
Their surname:

Their first names:

Their date of birth:

D D M M Y Y Y Y
Their nationality:

How is the child related

to you?

Is this child living with you? Yes No

If yes, the date they
came here:
D D M M Y Y Y Y
If no, what country do
they live in?

What is their PPS Number or the equivalent, for example, National Insurance Number, Pesel,
CNP or ID Number?

Notes: A separate sheet of paper can be used for more details if needed.

Page 8
Part 4 continued Details of your children

26. How many children live with you? age 0 to 15 age 16 to 17

27. If any children under 18 years of age are not living with you, please state the name of the
parent or guardian with whom the children live:

Their surname:

Their first names:

Their birth surname:

Their date of birth:

D D M M Y Y Y Y
Their address:

County Eircode
Their relationship to the
children:
Their PPS Number or the equivalent, for example, National Insurance Number, Pesel, CNP or
ID Number?

28. Are any of the children that you listed Adopted? Yes No
in question 25:
Fostered? Yes No

Not your own? Yes No

If yes, please state the social worker’s:

Surname:
First names:
Address:

County Eircode
Telephone number:
Email address:

29. Do you have legal custody of your children? Yes No

30. Do you support your children? Yes No

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Part 5 Your spouse, civil partner or cohabitant’s details

31. Their PPS Number:

32. Title, insert an X or Mr Mrs Ms Other

specify:
33. Their surname:

34. Their first names:

35. Their birth surname:

36. Their PPS Number or the equivalent, for example, National Insurance Number, Pesel, CNP or ID
Number:

37. Their date of birth:

D D M M Y Y Y Y

38. Their address:

Only answer
this question if
you do not live
together.
County Eircode

39. Their nationality:

40. Are they getting Child Benefit? Yes No

If yes, please state:

Reference number:

Last date of payment:

D D M M Y Y Y Y
Country that pays them:

Page 10
Part 5 continued Your spouse, civil partner or cohabitant’s details
41. Are they getting any other social protection benefit or pension? Yes No

If yes, please state:

Country that pays them:

Name of benefit or
pension:
Reference number:

42. Are they employed? Yes No

If yes, please state:

Name of country where
they work:
Name of country in which
they pay social insurance:

Name of their employer:

Date they started their

current employment:
D D M M Y Y Y Y

43. Are they self-employed? Yes No

If yes, please state:

Name of country where
they work:
Name of country in which
they pay social insurance:

Name of their employer:

Date they started their

current employment:
D D M M Y Y Y Y

Page 11
Part 6 Events that may affect your Child Benefit

You must notify the Child Benefit Section in writing if any of these events occur.
• You change address.
• You change post office, bank or building society.
• You change An Post Childcare Account or account name.
• A child aged 16 or 17 finishes education or changes or leaves school or college.
• There is a death of a child for whom benefit is being paid.
• You are imprisoned or your child is admitted to a home or detention centre.
• A child is no longer living with you or in your care.
• A child is abandoned, deserted or removed from your custody.
• You or your child leave the State.
• You marry or enter into a civil partnership or civil union.
• You or your spouse, civil partner or cohabitant start work in another EU country or the UK.
• The person receiving child benefit dies.
• You adopt or foster a child or give birth to a child outside of the state.
• Your family come to live in Ireland.

Part 7 Late application details

Claims should be submitted within 12 months of:
• the birth of the child;
• the child becoming a member of your household;
• you and your family moving to Ireland; and
• you or your spouse, civil partner or cohabitant commencing employment in Ireland.
Claims received outside this timeframe may result in loss of payment.
If you have not applied within 12 months and you wish to apply for arrears, please give the reasons
why in the space provided and attach evidence in support of your reasons if available.

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Part 8 Checklist
Note: To verify documents, please bring the original documents to any office of the Department
of Social Protection. Please note that only verified copies of the original versions of certificates
are acceptable. Translations of birth certificates on their own are not sufficient.

Have you completed and enclosed the following?

For all non-EU and non-EEA nationals, a verified copy of your certificate of registration, IRP
card and letter from the Minister for Justice. If your spouse or partner is not in employment, you
should also submit a verified copy of their certificate of registration, IRP card and letter from the
Minister for Justice.
Letter from school or college for each child of school going age confirming the dates your child
has been attending.
Letter from, playschool, crèche, Gardaí, or medical practitioner confirming residency of each
child not of school going age.

A completed and signed HRC1 form if the applicant is a non-EU or non-EEA national, or an
unemployed UK, EU or EEA national. The HRC1 form is available at www.gov.ie/hrc

A completed Child Benefit 2 (CB2) form for each child aged 16 or 17 years.
Relevant documents from the Department of Justice if you have applied for refugee or
residency status.
Completed question 21 if you have moved here from another country.

If your children are resident in another EU or EEA member state or the UK and do not have a
PPS Number:
Original or verified copies of birth certificates, which must include the parents names, for each
child you wish to claim for.

Sending in certificates or documents later

To avoid delay, please send all the certificates and documents that are needed with this form.
If you are sending in certificates or documents later, give details in the box below and include your
full name, present address and your PPS number with them.

Important Information
As part of the department’s control policy, Child Benefit claims are reviewed every 12 to 18 months
to check continued entitlement. This is done by issuing forms to be completed and returned by Child
Benefit claimants. If these forms are not returned to the Child Benefit Section, payments may be
suspended until continued entitlement is confirmed.

Page 13
Part 9 Declaration
I declare that the information given by me on this form is truthful and complete. I understand that if
any of the information I provide is untrue or misleading or if I fail to disclose any relevant information,
I will be required to repay any payment I receive from the department and that I may be prosecuted.
I undertake to immediately advise the department of any change in my circumstances which may
affect my continued entitlement.

Date: 2 0
D D M M Y Y Y Y
Signature, not capital letters.

Warning: If you make a false statement or withhold information, you may be prosecuted leading
to a fine, a prison term or both.

For official department use only

HRC satisfied HRC not satisfied HRC1 issued
I award payment of Child Benefit for the children named in Part 4.
I disallow payment of Child Benefit for the children named in Part 4.
With effect from: 2 0
M M Y Y Y Y

Date: 2 0
D D M M Y Y Y Y
Signature of deciding officer, not capital letters.

Send this completed form to:

Child Benefit Section
Department of Social Protection
St. Oliver Plunkett Road
Letterkenny
Co. Donegal
F92 T449

Important: Claims should be submitted within 12 months. If you have not applied within 12 months
please complete Part 7.

Data Protection Statement

The Department of Social Protection administers Ireland’s social protection system. Customers are
required to provide personal data to determine eligibility for relevant payments and benefits. Personal
data may be exchanged with other government departments and agencies where provided for by law.
Our data protection policy is available at www.gov.ie/dsp/privacystatement or in hard copy.

Explanations and terms used in this form are intended as a guide only and are not a legal interpretation.
20K 03-22 Edition: March 2022

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