State Pension (Contributory) Increase for Qualified Adult Application Form (SPCQA1)

Published date07 May 2021
IssuerDepartment of Social Protection
Your spouse, civil partner or cohabitant needs a Personal Public Service
Number (PPS No.) before you apply.
You must also give your own Personal Public Service Number (PPS No.).
How to complete this application form.
Please use this page as a guide to filling in this form.
Please answer all questions. Incomplete forms will be returned and this will
delay your application.
Please use BLACK ball point pen.
Please use BLOCK LETTERS and place an X in the relevant boxes.
Increase for Qualified Adult:
Please note that this increase is based on a means assessment. As you are
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 4 must be filled in and signed by your spouse, civil partner or cohabitant.
When the form is completed, you must sign the declaration in Part 1.
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.
Application form for:
State Pension (Contributory)
Increase for Qualified Adult
Data Classification R
Social Welfare Services
SPCQA 1

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