Change the Payment Frequency of Fuel Allowance Application Form (FA CPF1)

• Published date: 26 April 2021
• Issuer: Department of Social Protection

Application form to

Change the Payment Frequency of

Fuel Allowance

Part 1 Your details

Signature not capital letters.

Date:

D D M M Y Y Y Y

Data Classification R

Social Welfare Services

FA CPF 1

9. What payment do you get from

this department?

Your payment preference

Part 2

1. PPS Number:

2. Surname:

5. Date of birth:

3. First names:

4. Birth surname:

6. Address:

County Eircode

7. Telephone number:

8. Email address:

D D M M Y Y Y Y

What is this application form for?

You can use this application form to change the frequency of payment under the Fuel Allowance scheme.

For further information

For more information on the Fuel Allowance scheme please visit: www.gov.ie/fuel.

How to complete this application form

To complete this application form, please write with a black ballpoint pen, use capital letters and place

an X in the relevant boxes.

Two instalments

Weekly

Fuel Allowance is paid weekly or in two instalments. The rst instalment is paid at the start of the season

and the second is paid in January.

If you choose the two instalment option and the season has already started, you will receive weekly

payments until the next instalment payment is due and then your payment will change.

What would you like to change the frequency of your Fuel Allowance payment to? Put an X in one of the

boxes below: