Personal Reader Grant Claim Form

• Published date: 10 May 2021
• Issuer: Department of Social Protection

Personal Reader Grant

CLAIM FORM

Amended: 19/11/18 (Final version)

CLAIM FOR THE PERIOD OF _______ WEEKS FROM: _____/_____/_____ TO: _____/_____/_____

Week

Ending

Number of hours

reading per week

Amount paid to

Reader

€

Signature of Reader

Signature of Employer

Signature of Applicant

Please make the payment to:

Name: ______________________________________________________________ PPS No: ___________________________________________________

Address: _______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

as per attached EFT Bank Mandate (cross this line out if you have previously returned the EFT Bank Mandate).