State Pension (Non-Contributory) Application Form (SPNC1)

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

Application form for

State Pension

Non-Contributory

SPNC 1

Social Welfare Services

Data Classification R

What is State Pension Non-Contributory?

State Pension Non-Contributory is a means tested payment for people who do not qualify for a

State Pension Contributory or who only qualify for a reduced rate contributory pension based on

their social insurance record.

How do I qualify for State Pension Non-Contributory?

To get State Pension Non-Contributory you must:

• be 66 years of age or over;

• satisfy a means test; and

• be legally and habitually resident in the State.

How to complete this application form?

• tear o󰀨 this page, it has examples on the back that can be used as a guide to ll in this form; and

• write with a black ballpoint pen, use capital letters and place an X in the relevant boxes.

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

• ll in Parts 1 to 6;

• read Part 10 and sign the declaration in Part 1.

If you have a spouse, civil partner or cohabitant:

• ll in Parts 1 to 8;

• ask your spouse, civil partner or cohabitant to ll in Part 9; and

• read Part 10 and sign the declaration in Part 1.

Note: You should apply three months before reaching pension age. Incomplete forms will be

returned, and this may delay your application.

How do I apply?

Send this completed form to:

State Pension Non-Contributory Section

Department of Social Protection

College Road

Sligo

Co. Sligo

F91 T384

How can I get help and further information?

If you need any help to complete this form, please contact the State Pension Non-Contributory

section on 0818 200 400 or 071 915 7100. Your local Intreo Centre, Social Welfare O󰀩ce or any

Citizens Information Centre can also help. You can nd the name and address of your local Intreo

Centre or Social Welfare O󰀩ce by visiting www.gov.ie/intreocentres

For more information, visit www.gov.ie/spnc

How to fill this form

To help us in processing your application, print letters and numbers clearly and use one

box for each letter or number. Please see example below.

M M U R P H Y @ W E L F A R E . I E

10. Your telephone number:

11. Your email address:

Contact Details

1 N E W S T R E E T

OL D T OW N

DON E G A L T OW N

9. Your address:

County DON E G A L F 9 2 P C O3

Eircode

Your own detailsPart 1

0881234567

053931234 5

M O B I L E

L A N D L I N E

1. Your PPS Number:

3. Surname:

7. Your date of birth:

4. First names:

M U R P H Y

M A U R E E N

X

2 8 0 2 1 9 7 0

Mr. Mrs. Ms. Other

2. Title, insert an X or specify:

6. Birth surname: M C D E R M OT T

M A R Y

8. Your mother’s birth surname: G A L L A G H E R

1 2 3 4 5 6 7 T

D D M M Y Y Y Y

5.

Your first name as it appears

on your birth certificate:

SAMPLE