Form 1 Application for compensation; death on duty of a member of an Garda Síochána caused by malicious injury

• Published date: 01 February 2018
• Issuer: Department of Justice

Form No. 1

GÁRDA SÍOCHÁNA (COMPENSATION) ACT, 1941.

FORM OF APPLICATION FOR COMPENSATION

IN RESPECT OF THE DEATH OF A DECEASED PERSON.

1. Name and address of the Applicant

Note.—If more than one applicant, the names and addresses of all the applicants must be

stated here.

2. Is the applicant or any of the applicants under the age of twenty-one years, if so,

state his or her age and the name and address of the person making this

application on his or her behalf

3. Name and rank of the deceased person in respect of whose death the application

is made

4. Relationship of the applicant or each of the applicants to the said deceased

person.

5. Facts relied on to show that the applicant or each of the applicants was dependent

or partly dependent on the said deceased person