Irish Social Insurance Records Request Form (U1)

• Published date: 30 June 2021
• Issuer: Department of Social Protection

REQUEST FOR IRISH SOCIAL INSURANCE RECORDS

FORM U1

INFORMATION REQUIRED (BLOCK CAPITALS PLEASE)

First name

Surname

What is your Personal Public Service Number (PPSN)?

Nationality

Sex Male Female

Date of Birth Day

Date of entry into Ireland Day

Date of intended departure Day

from Ireland

Forwarding address

Contact phone number

Email address

Details of Irish employments

Month

Month

Month

Year

Year

Year

If you had more than 3 employments in Ireland, please provide details on a separate sheet.

*** Please do not attach another person’s application to yours ***

Name

Address

From To

Reason job ended

Name

Address

From To

Reason job ended

Name

Address

From To

Reason job ended

Reason job ended - examples include: resignation, contract expired, contract terminated by

mutual consent, contract terminated by employer, redundancy, dismissal for disciplinary reasons.