State Pension (Contributory) Application Form (SPC1)

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

You need a Personal Public Service Number (PPS No.) before you apply.

How to complete this application form.

• Please tear off this page and use as a guide to filling in this form.

• Please answer all questions. Incomplete forms will be returned and this may

delay your application.

• Please use BLACK ball point pen.

• Please use BLOCK LETTERS and place an X in the relevant boxes.

If you do not have a spouse, civil partner or cohabitant:

Fill in Parts 1 to 6 as they apply to you. When form is completed, read Part 10

and sign declaration in Part 1.

If you have a spouse, civil partner or cohabitant:

Fill in Parts 1 to 7 as they apply to you. You must complete Part 8 fully if you

wish to claim an increase for your spouse, civil partner or cohabitant. Please note

that this increase is based on a means assessment. If claiming this increase for

your spouse, civil partner or cohabitant, you are legally obliged to declare all of

their income (including foreign pensions), savings and property (other than your

own home). Part 9 must be filled in and signed by your spouse, civil partner or

cohabitant. When form is completed, read Part 10 and sign declaration in Part 1.

If you have lived or worked in another country:

We will apply for a pension on your behalf to those countries covered by EU

Regulations or Bilateral Agreements.

If you need any help to complete this form, please contact your local Citizens

Information Centre, your local Intreo Centre or your local Social Welfare Office.

For more information, log on to www.gov.ie/dsp.

Important:

You should apply 3 months before reaching pension age. If you do not claim

within 6 months of becoming eligible, you could lose some payment.

Application form for

State Pension (Contributory)

Data Classification R

Social Welfare Services

SPC 1

How to fill this form

To help us in processing your application:

• Print letters and numbers clearly.

• Use one box for each character (letter or number).

Please see example below.

SAMPLE

1234567T

M U R P H Y

M A U R E E N

M C D E R M O T T

2 8 0 2 1 9 7 0

1. Your PPS Number:

3. Surname:

8. Your date of birth:

4. First name(s):

D D M M Y Y Y Y

Mr. Mrs. Ms. Other

2. Title: (insert an X or

specify)

6. Birth surname:

5. Your first name as it

appears on your birth

certificate:

Contact Details

X

M A R Y

7 . Your mother’s birth

surname: K E L L Y

L A N D L I N E

M O B I L E

O N E C H A R A C T E R P E R

B O X

10.

Your telephone number:

11.Your email address:

O N E N U M B E R P E R B O X

O N E N U M B E R P E R B O X

1 N E W S T R E E T

O L D T O W N

D O N E G A L T O W N

9. Your address:

County D O N E G A L Postcode