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

Published date06 July 2021
IssuerDepartment 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:

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