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Send this completed application form to Disablement Benefit Section Government Buildings Ballinalee Road Longford Telephone 043 334 0000 LoCall 1890 92 77 70 If calling from outside the Republic of Ireland please call 353 43 334 0000 Note The rates charged for using 1890 LoCall numbers may vary among different service providers. 19. Their PPS No. 20. Their surname 21. Their first name s 22. Their birth surname 23. Their address 24. Signature of agent not block letters Part 6 Divorce or...
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