Jobseeker's Repeat Claim Application Form (UP6)

• Published date: 07 May 2021
• Issuer: Department of Social Protection

An Roinn Coimirce Sóisialaí

Department of Social Protection

- 1 - UP 6 5/21

REPEAT/TRANSFER CLAIM

Name: __________________________________ PPS No: ______________________

Address: __________________________________________________________________

_________________________________________________________________________

Phone Number: Land Line _____________________ Mobile _______________________

E-mail address: _______________________________Occupation: _________________

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1. What were you doing since your last claim? _______________________________

2. State name, address and phone no. of your most recent employer

3. Dates of employment:From _______________ To ________________

4. State number of days worked a week Number of hours worked a day

5. Why did this job finish? _________________________________________________________________

6. Are you available for full-time work? Yes No

7. Are you looking for work? Yes No

If you answered ‘No’ to questions 6 or 7, please state why.

8. Are you working casually, part-time etc. ? Yes No

Forms issued: UP 15UP 80

9. At what Post Office do you wish to be paid? ________________________________________________

Alternatively if you wish to be paid directly to your bank account please complete form USF 6. If you

are employed on a part-time basis you will be paid by EFT, form USF 6 must be completed.

Spouse/Civil Partner/Cohabitant’s Details

10. Spouse/Civil Partner/Cohabitant’s Name:____________________________ PPS No. ________________

11. Spouse/Civil Partner/Cohabitant’s average weekly earnings: €_______________ (please attach payslips)

12. If Spouse/Civil Partner/Cohabitant is in receipt of a Social Welfare/Health Service Executive/Solas payment,

please state: Type of payment: ________________________________ Weekly Amount: €_____________

Children’s Details

13. No. of children under age 18: _____ 13a. No. of children over age 18 in full-time education: _____

14. Are all your children living with you? Yes No

If ‘No’, list names of children not living with you: ___________________________________________

If claiming Jobseeker’s Benefit, please sign the declaration on page 3.

If claiming Jobseeker’s Allowance, please answer the questions on page 2 and sign the declaration on

page 3.

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