Application Form for Household Benefits Package

Submit the completed form and required documents via mail to the relevant Social Welfare office. Ensure that all sections are filled out accurately and that any additional documents, such as utility bills, are attached. For online submission options, follow the instructions provided at www.gov.ie. My advice is to double-check all information before submission to avoid any delays or issues with your application.

Please refer to the relevant department's website for important submission deadlines for 2024 and 2025.

The purpose of the Household Benefits Package application form is to assist eligible individuals and households in Ireland in applying for benefits that help with utility bills and television licenses. This form gathers essential information about the applicant's personal details, household composition, and income sources to determine eligibility. Completing this form accurately ensures that applicants receive the benefits they are entitled to, helping them manage their household expenses effectively. By providing truthful and complete information, applicants can avoid delays or issues with their benefit applications and receive the assistance they need in a timely manner.

• 1. PPS Number: Your Personal Public Service Number.
• 2. Title: Select your appropriate title such as Mr., Mrs., Ms., Other.
• 3. Surname: Your last name.
• 4. First name(s): Your first name(s).
• 5. Birth surname: Your surname at birth.
• 6. Date of birth: Your date of birth in the format DDMMYYYY.
• 7. Mother's birth surname: Your mother's surname at birth.
• 8. Address: Your current address including county and postcode.
• 9. Telephone number: Your contact numbers including mobile and landline.
• 10. Email address: Your email address.
• 11. Declaration: Your signature and date, declaring the information provided is true and complete.
• 12. Change of Address: Information about any recent changes to your address.
• 13. Living Status: Questions about your living situation, including residency in the state and if you live alone.
• 14. Pension and Income Details: Information about any pensions or income received from other sources.
• 15. Allowance Option: Selection of the allowance you are applying for, such as Electricity, Gas, Group Account, or Bottled Gas Allowance.
• 16. Television Licence: Your television licence number.

If you fail to submit this form, you may lose eligibility for the Household Benefits Package. Accurate and timely submission is crucial to receive the benefits you need.

• Loss of Benefits: You may not receive the financial assistance you are entitled to.
• Ineligibility for Future Applications: Failure to submit may affect future benefit applications.

• 1. Applying for Utility Bill Assistance: Use this form to apply for assistance with electricity, gas, or bottled gas bills.
• 2. Requesting Television Licence Benefit: Complete the form to apply for the television licence benefit.
• 3. Providing Personal and Household Information: Use this form to provide required personal and household details.
• 4. Updating Your Benefit Records: Submit this form to update your benefit records with any changes in your circumstances.
• 5. Means Testing for Eligibility: Ages 66-70 can use this form to request means testing for benefit eligibility.