Application form for
COVID Pandemic Unemployment Payment
Data Classification R
Social Welfare Services
COVID-UP
This is an emergency payment
The COVID-19 Pandemic Unemployment Payment is a payment of €350 per week. It is available to all
employees and the self-employed who have lost their income and are no longer employed as a result of
COVID-19.
First Name
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Surname
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PPS No
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Mother’s Birth Surname
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Address
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County
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E-mail address
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Date of Birth
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/
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/
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Phone Number
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Employer name, address and phone no. _______________________________________________
Last day worked/paid to
oo
/
oo
/2020 Why did this job nish? ______________________
Are you still working casually, part-time etc.? Yes
o
No
o
Are you in receipt of another weekly Social Welfare payment? Yes
o
No
o
Bank Account Details
Bank Name
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Account Name
ooooooooooooooooooooooo
BIC
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IBAN
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Please keep checking your Bank Account as payment may issue in advance of notication.
DECLARATION BY APPLICANT
I declare that I am fully unemployed, have lost my income and am not being paid by my employer at the
moment due to COVID-19.
I state that I will inform the Department if there are any changes in my circumstances which may aect my
entitlement to payment.
I know that it is an oence to provide false information or to withhold information to qualify for this payment.
Signed: ____________________________________ Date: _____/_____/2020
Applicant’s Signature
Return this form by FREEPOST to PO Box 12896, Dublin 1 or drop into your local Intreo Centre/Social Welfare Branch Ofce. You can
also apply for this payment online at www.mywelfare.ie
Data Protection Statement
The Department of Employment Affairs and Social Protection administers Ireland’s social protection system.Customers are required
to provide personal data to determine eligibility for relevant payments/benefits. Personal data may be exchanged with other
Government Departments/Agencies where provided for by law. Our data protection policy is available at
www.gov.ie/deasp/privacystatement
or in hard copy.
I award a payment to this customer
Signature of DP/DO: _____________________________ Date: _____/_____/2020
Name of DP/DO: ________________________________
For Ocial Use Only
click to sign
signature
click to edit
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signature
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Eligibility Notice for COVID-19
Pandemic Unemployment Payment
You are eligible to apply for the COVID-19
Pandemic Unemployment Payment if…
You were in employment or self-employment
immediately before Friday 13 March, and
You have been temporarily laid-off from work
or asked to stay at home from work, and
Your employer is not in a position to retain you
on their payroll, and
You are not in receipt of any employment income, and
You are between 18-66 years of age, and
You are resident in the Republic of Ireland.
You are not eligible to apply for the COVID-19
Pandemic Unemployment Payment if…
You were not in employment immediately before
Friday 13 March, or
You were not laid-off from work by your employer,
or
You are continuing to receive income from your
employment, or
You voluntarily left your employment.
Do not claim the COVID-19 Pandemic Unemployment Payment if your employer has not laid you off, or if you were
not previously in employment, or if you are still in receipt of employment income, or if your employer takes you back
onto their payroll.
If you think you inadvertently applied for the COVID-19 Pandemic Unemployment Payment, or if your employer has
re-employed you under the new Temporary Wage Subsidy Scheme, you must close your COVID-19 Pandemic
Unemployment Payment claim now. Claims can be closed via the Department’s online portal at www.MyWelfare.ie
under the COVID-19 payment section.
The Department will review all claims. It is engaging with Revenue Commissioners to identify those workers not
eligible to avail of the COVID-19 Pandemic Unemployment Payment and will take steps to recover any incorrect
payment. Any person who knowingly claims the payment in circumstances where they are not entitled to the payment
will be prosecuted.
The co-operation of the public in ensuring that only correct claims are submitted is greatly appreciated. This ensures
that we can process claims for people who really need the support as quickly as possible.
The COVID-19 Pandemic Unemployment Payment is an emergency payment of €350 per week introduced by the
Government. It is available to employees and the self-employed who have lost their employment and income on (or
after) 13 March due to the COVID-19 (Coronavirus) pandemic.
0K 04-20 Edition: April 2020
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