Personal Public Service (PPS) Number Application Form (REG1)

• Published date: 06 July 2021
• Issuer: Department of Social Protection

Page 1

Part 1

2. Surname:

7. Date of birth:

3. First names:

1. Title, insert an X or specify:

5. Birth surname:

4. Birth first names:

10. Telephone numbers:

11. Email address:

6. Mother’s birth surname:

D D M M Y Y Y Y

Application form for

Personal Public Service (PPS) Number

Mr Mrs Ms Other

Data Classification R

Social Welfare Services

REG 1

Male Female

8. Gender:

9. Address:

What is this application form for?

This application form is used to apply for a Personal Public Service (PPS) Number.

For further information and how to get help

For further information on the application process and documents required, please visit

www.gov.ie/ppsn

How to complete this application form

To complete this application form, please write with a black ballpoint pen, use capital letters and

place an X in the relevant boxes.

12. Why do you need a Personal Public Service (PPS) Number?

County Eircode

Your details

Mobile

Landline

13. Nationality: