Habitual Residence Condition Application Form (HRC1)

• Published date: 23 April 2021
• Issuer: Department of Social Protection

on

Application form for

Habitual Residence Condition

What does Habitual Residence mean?

Being habitually resident means that you are living in the Republic of Ireland and can prove

that you have a close link to the State.

How do I qualify for Habitual Residence?

Factors taken into consideration when deciding if a person is habitually resident in the Republic

of Ireland include:

• If you were born and raised here;

• If you have a right to live here;

• The length of time you have lived here and if you have lived here continuously;

• If you have worked here;

• If you have close family ties or ties with the community here; and

• Your general living situation here.

Time spent outside the Republic of Ireland on short holidays, studying or travelling does not

exclude a person from being regarded as habitually resident

What do I need to complete this form?

• You need a Personal Public Service (PPS) Number before you apply.

How do I complete this application form?

• There is an example on the back of this page that can be used as a guide to ll in this form.

• Write with a black ballpoint pen.

• Use BLOCK LETTERS and place an X in the relevant boxes.

• Answer all the questions as incomplete forms will be returned and this may delay your

application.

• Sign the declaration in Part 1.

How can I get help and further information?

If you need any help to complete this form, please 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/intreo

For more information on the Habitual Residence Condition visit www.gov.ie/hrc

Data Classification R

Social Welfare Services

HRC 1

Thank you for your application for

D D M M 2 0 Y Y

However, we need more information to decide if you are habitually resident in the

Republic of Ireland. Please answer the questions in this form to help us decide.

Page 2

How to fill in this form

1 2 3 4 5 6 7 T

M U R P H Y

M A U R E E N

M C D E R M O T T

Mr Mrs Ms Other

Contact Details

X

M A R Y

K E L L Y

1. Your PPS Number:

3. Surname:

4. First names:

2. Title, insert an ‘X’ or

specify:

6. Birth surname:

5. Your first name as it

appears on your birth

certificate:

8 . Your mother’s birth

surname:

2 8 0 2 1 9 7 0

D D M M Y Y Y Y

7. Your date of birth:

Landline

Mobile

O N E C H A R A C T E R P E R

B O X

10. Your telephone numbers:

11. Your email address:

O N E N U M B E R P E R B O X

O N E N U M B E R P E R B O X

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

9. Your address:

County D O N E G A L C 1 5 A 9 6 V

Eircode

SAMPLE

To help us to process your application write letters and numbers clearly and use one box

for each. Please see examples below.

Part 1 Your own details