Social Welfare Services

Application form for WFP 1

Working Family Payment (WFP) Data Classification R

What is Working Family Payment?

Working Family Payment is a weekly tax-free payment for employees with children. It gives extra
financial support to families with children depending on their incomes and family size.
How do I qualify for Working Family Payment?
You can qualify for Working Family Payment if:
• Your income is calculated to be below a certain amount;
• You have one or more children;
• You work 38 hours or more a fortnight in paid employment. You can also combine your
weekly hours with your partner’s hours to help meet this requirement;
• You are the highest earner in your relationship; and
• Your employment is expected to continue for at least three months.

What do I need to complete this application form?

You will need your Personal Public Service (PPS) Number along with information on where you
live, your children, your relationship status and where you want your payment to issue. You will also
need to provide:
• Your children’s and partner's date of birth and PPS Numbers;
• Details of your and your partner's employment status and information from your most recent
payslips;
• Details of any income you or your partner receive from all sources in Ireland and abroad; and
• A letter from the school or college, that your children attend, if they are between 18 and 22 years
of age and in full time education.

How do I apply?
• You can apply online at MyWelfare.ie; or
• Send this completed form to:
Working Family Payment Section
Department of Social Protection
Social Welfare Services Office
Ballinalee Road
Longford
N39 E4E0
How to complete this application form?
• Use this page as a guide to filling in this form. There are examples on the back.
• Use black ballpoint pen.
• Use BLOCK LETTERS and place an X in the relevant boxes.
• Answer all questions that apply to you, leave blank any that don’t apply.
• Read Part 7 checklist and sign the declaration in Part 1.
If you need any help to complete this form, please contact the Working Family Payments Section
on 0818 927 770 or (043) 334 0000. You can also contact your local Intreo Centre, Social Welfare
Office or any Citizens Information Centre. You can find the name and address of your local Intreo
Centre or Social Welfare Office by visiting www.gov.ie/intreocentres
For more information on Working Family Payment visit www.gov.ie/WFP
 How to fill in this form

To help us to process your application, write letters and numbers clearly and use one box
for each. Please see examples below.

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

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

3. Surname: M U R P H Y

4. First names: M A U R E E N
5. First names as they appear
M A R Y
on your birth certificate:

6. Birth surname: M C D E R M O T T

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

D D M M Y Y Y Y
8. Your mother’s birth surname: K E L L Y

Contact Details
9. 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 A 6 5 F 4 E 2

10. Your mobile number: 0 8 8 1 2 3 4 7 8 9

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

SAMPLE
 For Official Use Only Social Welfare Services
Application form for Exp Date WFP 1

Working Family Payment (WFP) Data Classification R

Part 1 Your own details

1. Your PPS Number:
2. Title, insert an X or specify: Mr Mrs Ms Other
3. Surname:

4. First names:
5. First names as they appear
on your birth certificate:
6. Birth surname:
7. Your date of birth:
D D M M Y Y Y Y
8. Your mother’s birth surname:

Contact Details
9. Your address:

County Eircode
10. Your mobile number:
Your phone number may be used to contact you with regards to the status of your application.
11. Your email address:

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, 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.
If you cannot sign your name, make a mark, such as an X and have it witnessed.
Date: 2 0
D D M M Y Y Y Y
Signature not block letters.

Date: 2 0
D D M M Y Y Y Y
Signature of witness not block letters.
Warning: If you make a false statement or withhold information, you may be prosecuted leading to
a fine, a prison term or both.
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Part 1 continued Your own details
12. 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)

Your spouse’s, civil partner’s or

Part 2
cohabitant’s details
If you have a spouse, civil partner or cohabitant, please state:

13. Their PPS Number:

14. Title, insert an X or specify: Mr Mrs Ms Other

15. Their surname:

16. Their first names:

17. Their birth surname:

18. Their date of birth: D D M M Y Y Y Y

19. Their address:

Only answer this
question if you are
married or in a civil
partnership and do not
live together.

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Part 3 Details of your children
20. How many children do you wish to claim for?

under age 18 age 18 - 22 in full-time education

You must attach written confirmation from the school or college for children aged 18 - 22.
If you are claiming for children, please provide their details below.
Child 1
First names:

PPS Number:

Date of birth: D D M M Y Y Y Y
Does the child
Yes No
live with you?

Child 2
First names:

PPS Number:

Date of birth: D D M M Y Y Y Y

Does the child Yes No

live with you?
Child 3
First names:

PPS Number:

Date of birth: D D M M Y Y Y Y

Does the child Yes No

live with you?

Child 4
First names:

PPS Number:

Date of birth: D D M M Y Y Y Y

Does the child Yes No

live with you?

Note: A separate sheet of paper can be used for details of other children you have.

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 Your and your spouse’s, civil partner’s or
Part 4 cohabitant’s work and income details
21. What is your employment status?

Employed Self-employed Employed and Unemployed

self-employed

If employed, provide your employer's details:

Employer’s name:

Employer’s address:

Employer’s registered
number:
Employer’s telephone
number:

Employer’s email address:

When did you start D D M M Y Y Y Y

this job?

22. How many hours do you

work a fortnight?

23. What is your hourly

rate of pay?
€ .

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 Your and your spouse’s, civil partner’s or
Part 4 continued cohabitant’s work and income details
24. What is your spouse's civil partner's or cohabitant's current employment status?

Employed Self-employed Employed and Unemployed

self-employed

If employed provide their employer's details:

Employer’s name:

Employer’s address:

Employer’s registered
number:
Employer’s telephone
number:

Employer’s email address:

When did they start D D M M Y Y Y Y

their job?

25. How many hours do they

work a fortnight?

26. What is their hourly

rate of pay?
€ .

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 Your and your spouse’s, civil partner’s or
Part 5 cohabitant’s financial information

You will need your own and your spouse's, civil partner's or cohabitant's most recent payslip to
answer the questions below.
For questions 27 and 28 below, year to date (YTD) figures are required. Year to date figures are
higher than the figures for this period of pay. All payslips have different terms so please review
the questions carefully to help you locate the correct figures from your payslip.
Learn more about where to find appropriate figures on your payslips at www.gov.ie/wfp

27. What are your insurable weeks worked, pay and tax details?
Year to date You Spouse, civil partner or cohabitant
Insurable weeks worked
Taxable pay € €
USC € €
Tax € €
PRSI € €

28. Are you, your spouse, civil partner or cohabitant self-employed?

You Spouse, civil partner or cohabitant
Yes No Yes No
If yes, please state:
What is your
self-employment source?

Net profit: € €

If yes, please insert a copy of your or your spouse, civil partner or cohabitants most recent accounts.

29. Are you, your spouse, civil partner or cohabitant receiving maintenance?
You Spouse, civil partner or cohabitant
Yes No Yes No
If yes, please state:
How often is
Weekly Monthly Weekly Monthly
maintenance received?
Amount: € €

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 Your and your spouse’s, civil partner’s or
Part 5 continued
cohabitant’s financial information

Maintenance is where you receive financial contributions from a former spouse, civil partner,
cohabitant or parent of your children.
If you answered yes to Question 29, please complete Question 29(a)

29(a). Are you, your spouse, civil partner or cohabitant paying rent or a mortgage?

You Spouse, civil partner or cohabitant

Yes No Yes No
If yes, please state:
How often is the rent
Weekly Monthly Weekly Monthly
or the mortgage paid?
Amount: € €

30. Do you, your spouse, civil partner or cohabitant rent out a room, property or land?

You Spouse, civil partner or cohabitant

Yes No Yes No
If yes, please state:
How often is rental
income received? Weekly Monthly Weekly Monthly

Amount: € €

31. Do you, your spouse, civil partner or cohabitant receive a private pension? Irish State pension
should not be included.
You Spouse, civil partner or cohabitant
Yes No Yes No
If yes, please state:
How often is private
pension received? Weekly Monthly Weekly Monthly

Amount: € €

32. Do you, your spouse, civil partner or cohabitant receive income from attending any education
or training course? This includes SOLAS, VTOS, FETAC, Community Employment (CE), Tús
Gateway and Rural Social Scheme (RSS).
You Spouse, civil partner or cohabitant
Yes No Yes No
If yes, please state:
How often is income
received? Weekly Monthly Weekly Monthly

Amount: € €
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 Your and your spouse’s, civil partner’s or
Part 5 continued
cohabitant’s financial information
33. Do you, your spouse, civil partner or cohabitant receive an income from another country?

You Spouse, civil partner or cohabitant

Yes No Yes No
If yes, please state:
How often is the
income received? Weekly Monthly Weekly Monthly

From which country?

Amount: € €

If you are unsure if an income you receive is considered for Working Family Payment, please provide
details in the box below. We will decide if it is assessed as income.

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Part 6 Your payment details
Please provide your current, deposit or savings account details for payment.
The account must be in your name or jointly held by you.
You will find the details requested below printed on statements from your financial institution.
Name of financial institution:
Bank Identifier Code (BIC):
International Bank Account
Number (IBAN):

Names of account holders:

Name 1:

Name 2, if any:

Part 7 Checklist
Have you:
Answered all the questions?
Completed all the employment details?
Provided bank details into which your payment can be made?
Signed the Declaration in Part 1?
Have you enclosed the following:
Your own most recent payslip.
Your spouse, civil partner or cohabitant’s most recent payslip.
Copy of most recent accounts if you, your Spouse, Civil Partner or cohabitant are self-employed.
A letter from the school or college, that your children attend, if they are between 18 and 22 years
of age and in full time education? Please refer to question 20.
If you started work recently and you don’t have all these details, we will look for information
about your employment later.
Send this completed application form to:
Working Family Payment Section
Department of Social Protection
Social Welfare Services
Government Buildings
Ballinalee Road
Longford
N39 E4E0
For more information
Visit: www.gov.ie/WFP
Email: wfpnewclaims@welfare.ie
Phone: 0818 927 770 or (043) 334 0000
If you have any difficulty in filling in this form, please contact the Working Family Payment Section,
your local Intreo Centre, Social Welfare Office or any Citizens Information Centre.

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 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 or agencies where provided for by law.
Our data protection policy is available at www.gov.ie/dsp/privacystatement or as a hard copy.

Explanations and terms used in this form are intended as a guide only and are not a legal interpretation.
00K 03-22 Edition: March 2022

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