Guardian's Payment Additional Child Application Form (GP1(A))

• Published date: 27 July 2021
• Issuer: Department of Social Protection

Page 1

Application form for Additional Child

Guardian’s Payment

Contributory or Non-Contributory

Social Welfare Services

GP1(A)

Data Classification R

Part 1 Your own details

1. Your PPS Number:

This must be accompanied by a GP1 Application Form

Part 2

2. Surname:

4. PPS Number:

3. First names:

5. Date of birth:

D D M M Y Y Y Y

Yes No

7. Are they living with you?

Please state child’s:

6. Relationship to you:

8. If Yes, what date this child

come into your care?

D D M M Y Y Y Y

Yes No

9. Have you adopted this

child?

If No, are you in the

process of adopting this

child?

Yes No

11. What were the circumstances of this child coming into your care?

Child’s details

10. Is there a social worker acting for this child?

Yes No

If Yes, please state their:

Name:

Telephone number:

Please attach a report form the social worker in support of your Guardian’s Payment claim

confirming parental abandonment and failure to provide.