Gender Recognition Certificate Revocation Application Form (GRC3)

Published date26 April 2021
IssuerDepartment of Social Protection
Application form to revoke
a Gender Recognition Certificate Data Classification R
Social Welfare Services
GRC 3
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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Please use  ball point pen.
Please use BLOCK LETTERS and place an X in the relevant boxes.
Please answer  " ! . If you do not answer all the questions we may not
be able to process your application.
$1!1%
Complete !1& of this application form.
Sign the declaration at !1' of this form and have it witnessed by one of the
following: 1 /!%1"/ 11! /
!. Send the completed application form, along with the relevant required
documents from the list below, to:
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If you need any help to complete this form, please contact Client Identity
Services, Telephone: 071 9672588.
"1"!
Birth Certificate or Adoption Certificate.
Gender Recognition Certificate.
Any other relevant documentation.
If you wish to have a name other than that on your Gender Recognition
Certificate shown on the Department’s central records database, we require
evidence of “use and repute” over two years or a Deed Poll for a change of name
which has been enrolled in the High Court.
For more information, log on to $$$*gov*.

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