International Protection Act 2015 (Application for International Protection Form) Regulations 2016.

• Jurisdiction: Ireland
• Citation: IR SI 660/2016

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of 6th January, 2017.

I, FRANCES FITZGERALD, Minister for Justice and Equality, in exercise of the powers conferred on me by sections 3 and 15 (5) of the International Protection Act 2015 (No. 66 of 2015), hereby make the following regulations:

1. (1) These Regulations may be cited as the International Protection Act 2015 (Application for International Protection Form) Regulations 2016.

(2) These Regulations shall come into operation on 31 December 2016.

2. The form set out in the Schedule is prescribed for the purposes of section 15 (5) of the International Protection Act 2015 (No. 66 of 2015).

Schedule

International Protection — Application Form

Application for International Protection to the Minister for Justiceand Equality in accordance with Section 15 of the International Protection Act, 2015.

International Protection Office,

Irish Naturalisation and Immigration Service,

79 — 83 Lower Mount Street,

Dublin 2.

I hereby apply for international protection in Ireland in accordance with Section 15 of the International Protection Act, 2015.

NOTE: MORE DETAILED INFORMATION ON THE REASON FOR YOUR APPLICATION MAY BE PROVIDED IN THE INTERNATIONAL PROTECTION QUESTIONNAIRE

(i) FAMILY NAME: (ii) FORENAME: (iii) DATE OF BIRTH: (iv) COUNTRY WHERE BORN: (v) NATIONALITY: (vi) IF NO NATIONALITY, COUNTRY OF HABITUAL RESIDENCE: (vii) ADDRESS IN OWN COUNTRY: (viii) NAME OF SPOUSE/PARTNER, IF APPLICABLE:(please complete a separate line for each person.) (ix) DATE OF BIRTH AND CURRENT WHEREABOUTS:

This form must be completed in English

(x) NAMES OF CHILDREN UNDER 18 YEARS OF AGE, IF APPLICABLE:(please complete a separate line for each person, specify their gender and specify exact nature of relationship to applicant for each). (xi) DATE OF BIRTH AND CURRENT WHEREABOUTS: (xii) NAMES OF YOUR PARENTS(please complete a separate line for each person) (xiii) DATE OF BIRTH AND THEIR CURRENT WHERABOUTS

Please provide all the reasons why you are claiming international protection.

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