S.I. No. 74/1927 - Army Pensions (Forms of Application) Regulations (No. 1), 1927.

1. Name

2. Address

3. Name of deceased Officer or Soldier

4. Army Number

5. Rank

6. Unit and Corps

7. Give the date of marriage of deceased

(Certificate of marriage to be attached).

8. When and where, and in what circumstances, was the deceased killed

9. If the deceased received in the course of duty a wound or injury which was the sole cause of his death subsequently, state :—

(a) the nature of the wound or injury

(b) the date upon which the wound or injury was received

(c) the district in which it was received, and

(d) any other circumstances within your knowledge

10. Give the names and addresses of any hospitals the deceased was in, or doctors who attended him since the receipt of the wound or injury referred to in your reply to above question 9

11. Give the following particulars of children living :—

(a) Where the Deceased was an Officer

Full Name of each Son under 18

Date of Birth

i

Full Name of each Daughter under 21

Date of Birth

(Birth Certificates must be attached.)

(

b

) State the amount expended within the last twelve months in educational fees on each of the children over eleven years and under eighteen years, mentioned in your reply to Question 11.

Name of Child

£ s. d.

(Receipts for School fees should be attached.)

(

c

) Where the Deceased was a Soldier

Full Name of each Son under 16

Date of Birth

Full Name of each Daughter under 18

Date of Birth

(Birth Certificates must be attached.)

12. State whether any compensation has been paid from or on behalf of any person alleged to be responsible for the act, which caused the death, wound, or injury, referred to in your reply to above questions 8 and 9. If so, give full particulars

13. Give particulars of any payments you have received from Army Funds since the death of the deceased

This statement has been read over by/to me. It is my own statement, and is correct and complete. I have nothing to add to it.

(Signed*)

............................................................ ..

Address

........................................................

(Applicant.)

(Signed*)

............................................................ ..

Address

........................................................

(Witness.)

Qualification of Witness

.......................................

Date

............................................................ ....

To be signed by one of the following :—

A Commissioned Officer serving in the Defence Forces.

A permanent Civil Servant (active or retired) whose salary is or was not less than £200 and on a scale rising to not less than £300.

A District Justice.

A Peace Commissioner.

A Barrister-at-Law, a Solicitor, or a Commissioner for Oaths.

A Minister of Religion (denomination to be stated).

A Registered Physician or Surgeon.

Managers, Secretaries, Chief Cashiers and Accountants of Banks, and Officials in charge of Branch Banks.

A member of Gárda Síochána.

A Postmaster or Postmistress in actual charge of a Post Office.

Head Teachers of Secondary or National Schools.

A Secretary of a Registered Friendly Society.

14. State the amount expended within the last twelve months in educational fees on each of the children over twelve years and under eighteen years, mentioned in your reply to Question 13.

Name of Child

£ s. d.

(Receipts for School Fees should be attached.)

The above statement has been read over by/to me. It is my own statement. I have nothing to add to it.

(Signed)

............................................................ ......

Address

............................................................

(Applicant.)

(Signed*)

............................................................ ......

Address

............................................................

(Witness.)

Qualification of Witness

.....................................

Date

............................................................ ....

*To be signed by one of the following :—

A Commissioned Officer serving in the Defence Forces.

A Permanent Civil Servant (active or retired) whose salary is or was not less than £200, and on a scale rising to not less than £300.

A District Justice.

A Peace Commissioner.

A Barrister-at-Law, a Solicitor or a Commissioner for Oaths.

A Minister of Religion (denomination to be stated).

A registered Physician or Surgeon.

Managers, Secretaries, Chief Cashiers, and Accountants of Banks and Officials in charge of Branch Banks.

A member of the Gárda Síochána.

A Postmaster or Postmistress in actual charge of a Post Office.

Head Teachers of Secondary or National Schools.

A Secretary of a Registered Friendly Society.

(THIRD SCHEDULE.—WOUNDS.)

A.P. 34.

ARMY PENSIONS ACT, 1927

.

APPLICATION BY A PERSON CLAIMING A WOUND PENSION UNDER SECTION 12 OF THE ACT.

NOTE.—This statement is to be filled in by the Applicant, or for him should he be illiterate. (The Applicant's statement will be checked from official records.)

15. (a) If your wife is dead or the marriage has been dissolved, state the names and ages of any (To be filled in by ex-Officers) Sons under 18 years of age

Daughters under 21 years of age (To be filled in by ex-Soldiers)

Sons under 16 years

Daughters under 18 years

(Certificate of birth of living children to be attached).

(b) State whether the child or children mentioned above are dependent on you, and where they are living

(c) State whether any of the above children are married

16. If your wife is alive, but your marriage has been dissolved, and you claim a further pension in respect of the children mentioned in the reply to Question 15 (a) above, please furnish copy of the decree or order of the Court

The above statement has been read over by/to me. I agree to it, and have nothing further to add to it.

(Signed)

............................................................ ..

Address

........................................................

(ex-Officer or ex-Soldier)

(Signed*)

............................................................ ..

Address

........................................................

(Witness.)

Qualification of Witness

..........................................

Date

............................................................ ....

*To be signed by one of the following —

A Commissioned Officer serving in the Defence Forces.

A Permanent Civil Servant (active or retired) whose salary is or was not less than £200, and on a scale rising to not less than £300.

A District Justice.

A Peace Commissioner.

A Barrister-at-Law, a Solicitor or a Commissioner for Oaths.

A Minister of Religion (denomination to be stated).

A registered Physician or Surgeon.

Managers, Secretaries, Chief Cashiers, and Accountants of Banks and Officials in charge of Branch Banks.

A member of the Gárda Síochána.

A Postmaster or Postmistress in actual charge of a Post Office.

Head Teachers of Secondary or National Schools.

A Secretary of a Registered Friendly Society.

SIXTH SCHEDULE.

A.P. 32.

ARMY PENSIONS ACTS, 1923 AND 1927.

APPLICATION BY A WIDOW FOR AN ALLOWANCE OR GRATUITY FOR HERSELF OR FOR HERSELF AND CHILDREN, UNDER

SECTION 15

(1) OF THE

ARMY PENSIONS ACT, 1927

.

NOTE.—This form is to be filled in by the Applicant in person, in her own words, and the form is to be signed by her and the signature witnessed. In the event of the Applicant being unable to write, she should affix her mark, such act being witnessed.

Name of Applicant (To be written in block capitals)

............................................................ .....................

(Surname)

(Christian Name)

Address

............................................................ ............................................................ ...................................

Nearest Gárda Síochána Station

............................................................ ......................................................

Name of deceased Officer or Soldier

............................................................ ................................................

Army Number

............................................................ ............................................................ ..................

Rank

............................................................ ............................................................ .........................................

Unit and Corps

............................................................ ............................................................ ..................

NOTE.—Before answering any of the questions below, the Applicant is to note that the statements made will be checked from official records.

Section 12 (1) of the Act imposes a summary penalty for a false declaration.

" Every person who, with a view to obtaining the grant or payment of a pension, allowance or gratuity under this Act, either for himself or for any other person, makes, signs, or uses any declaration, application, or other written statement, knowing the same to be false, shall be guilty of an offence under this Section, and shall be liable on summary conviction thereof to a fine not exceeding twenty-five pounds or, at the discretion of the court, to imprisonment for any term not exceeding six months or to both such fine and such imprisonment."

If the Applicant is unable to read, the above notes should be read over to her by the witness, who should so testify in his attestation of the claim.

17. Give the names and addresses of his Employers

(a) During the three years prior to joining the particular Military Force in which it is claimed he contracted the disability (or disabilities) which caused his death.

(b) During the period of his Service with the Irish Volunteers or Irish Citizen Army

(c) During the period since the cessation of his Military Service and prior to his death

18. Give particulars of any period or periods of unemployment since the cessation of the Military Service of the Deceased, and the cause of it (e.g., trade depression, ill-health, etc.)

19. Did either the Deceased or yourself receive compensation from the Deceased's employers, or from any person in respect of any accident, injury or disease and, if so, give full particulars and state the amount of such compensation

20. Give the names and addresses of any doctors who attended the Deceased since the cessation of his Military Service

21. If the Deceased was treated at a hospital (either as an in-patient or an out-patient) since the cessation of his Military Service, give the name of the hospital or hospitals, dates of admission, or commencement of treatment, and the nature of the ailment for which treated

22. Give particulars of the health of Deceased since the cessation of his Military Service. These should be supported by

(a) Medical certificates from any civilian doctors who attended him, and reports from non-Military hospitals which Deceased attended

(b) Certificates from Deceased's employers as to health and time lost

23. Have you received, or did the Deceased receive, in respect of the disability (or disabilities) which caused his death, any payment

(a) On a decree under the Criminal Injuries (Ireland) Acts, 1919 and 1920

(b) On an award made by the Personal Injuries Committee

(c) From any relief organisation, such as National Aid or White Cross Association ? If so, give full particulars

24. Give the name of Deceased's National Health Approved Society, and (if possible) his membership number

25. Did the Deceased make a claim for a certificate of service under the

Military Service Pensions Act, 1924

? If so, what was the result of this claim

26. State whether Deceased was at any time in receipt of a pension, allowance or gratuity in respect of injuries received or disability incurred in the course of service with any of the following Military or Police Forces

(a) British

(b) Australian

(c) New Zealand

(d) South African

(e) Canadian

(f) American (U.S.A.)

(g) Royal Irish Constabulary

(h) Dublin Metropolitan Police

(i) Gárda Síochána

27. Give particulars of any payments you have received from Army Funds since the death of Deceased

28. If you are supporting any children of the Deceased, give particulars as follows

(

a

) Where the Deceased was an Officer

Full Name of each Son under 18

Date of Birth

Full Name of each Daughter under 21

Date of Birth

(Birth Certificates must be attached.)

(

b

) Where the Deceased was a Soldier

Full Name of each Son under 16

Date of Birth

Full Name of each Daughter under 18

Date of Birth

(Birth Certificates must be attached.)

29. State the amount expended within the past twelve months in educational fees on each of the children over twelve years and under eighteen years, mentioned in your reply to Question 28.

Name of Child

£ s. d.

(Receipts for School Fees should be attached.)

The above statement has been read over by/to me. It is my own statement, and is correct and complete. I have nothing to add to it.

(Signed)

............................................................ ..

Address

........................................................

(Applicant.)

(Signed*)

............................................................ ..

Address

........................................................

(Witness.)

Qualification of Witness

..........................................

Date

............................................................ ....

* To be signed by one of the following :—

A Commissioned Officer serving in the Defence Forces.

A Permanent Civil Servant (active or retired) whose salary is or was not less than

£

200, and on a scale rising to not less than

£

300.

A District Justice.

A Peace Commissioner.

A Barrister-at-Law, a Solicitor or a Commissioner for Oaths.

A Minister of Religion (denomination to be stated).

A registered Physician or Surgeon.

Managers, Secretaries, Chief Cashiers, and Accountants of Banks and Officials in charge of Branch Banks.

A member of the Gárda Síochána.

A Postmaster or Postmistress in actual charge of a Post Office.

Head Teachers of Secondary or National Schools.

A Secretary of a Registered Friendly Society.

(SIXTH AND SEVENTH SCHEDULES.)

A.P. 31.

ARMY PENSIONS ACTS, 1923 AND 1927.

WOUND PENSION OR GRATUITY.

APPLICATION BY AN EX-OFFICER OR EX-SOLDIER OR EX-VOLUNTEER FOR A WOUND PENSION OR GRATUITY IN RESPECT OF A WOUND OR INJURY INCURRED IN THE COURSE OF HIS DUTY BEFORE THE 1ST OCTOBER, 1924, UNDER SECTION 1 OR

SECTION 3

of THE

ARMY PENSIONS ACT, 1923

, AS AMENDED BY THE

ARMY PENSIONS ACT, 1927

, OR

SECTION 11

of THE

ARMY PENSIONS ACT, 1927

.

The questions are to be answered in the ex-Officer's or ex-Soldier's own words, and the form is to be signed by him and the signature witnessed. In the event of the ex-Soldier being unable to write, he should affix his mark, such act being witnessed.

Army No.

.........................................................

Rank

............................................................ ............

Unit and Corps

............................................................ ............................................................ ..................

Name and Rank of Commanding Officer

............................................................ ......................................

............................................................ ............................................................ .........................................................

(Name (To be written in block capitals)

............................................................ ......................................

(Surname)

(Christian Names.)

Present Address

............................................................ ............................................................ ..................

Nearest Gárda Síochána Station

............................................................ ......................................................

NOTE.—Before answering the questions below, the applicant is to note that

(

a

) The statement made by him will be checked from official records.

Section 12 (1) of the Act imposes a summary penalty for a false declaration

" Every person who, with a view to obtaining the grant or payment of a pension, allowance, or gratuity under this Act, either for himself or for any other person, makes, signs, or uses any declaration, application, or other written statement knowing the same to be false, shall be guilty of an offence under this Section, and shall be liable on summary conviction thereof to a fine not exceeding twenty-five pounds or, at the discretion of the court, to imprisonment for any term not exceeding six months or to both such fine and such imprisonment."

(

b

) In answering Question 2 (

a

) any special matters which, in his opinion, caused any unfitness from which he may be suffering, should be clearly stated.

If the applicant is unable to read, the above notes should be read over to him by the witness, who should so testify in his attestation of the claim.

STATUTORY RULES AND ORDERS. 1927. No. 74.

ARMY PENSIONS (FORMS OF APPLICATION) REGULATIONS (No. 1), 1927.

WHEREAS it is enacted by sub-section (1) of

section 27

of the

Army Pensions Act, 1927

(No. 12 of 1927) that the Minister for Defence may by order make regulations in regard to any matter or thing referred to in that Act as prescribed or as being or to be prescribed by regulations made under that Act

AND WHEREAS it is enacted by section 17 of the said

Army Pensions Act, 1927

, that every application for the grant of a pension, gratuity or allowance under the

Army Pensions Act, 1923

(No. 26 of 1923) as amended by the said

Army Pensions Act, 1927

, or under the said

Army Pensions Act, 1927

, shall be made to the Minister for Defence in the prescribed form and shall contain the prescribed particulars

AND WHEREAS it is enacted by

section 11

of the

Ministers and Secretaries Act, 1924

(No. 16 of 1924) that it shall be lawful for any Minister pursuant to any arrangement or agreement previously authorised by an Order of the Executive Council to exercise and perform any of the duties or public services of any other Minister as agent for such Minister and without relieving such other Minister of his responsibility for the administration of such public service

AND WHEREAS by an Order entitled the Minister for Defence (Agency) Order, 1927, dated the 24th day of June, 1927, made by the Executive Council in pursuance of the said section 11 of the said

Ministers and Secretaries Act, 1924

, the President is authorised to exercise and perform as agent for the Minister for Defence any of the duties and public services of the Minister for Defence during the inability of that Minister through ill-health to exercise and perform such duties and public services

NOW, I, LIAM T. MACCOSGAIR, President of the Executive Council, in exercise of the powers conferred on the Minister for Defence by the

Army Pensions Act, 1927

(No. 12 of 1927), and of the powers conferred on me by the Minister for Defence (Agency) Order, 1927, made by the Executive Council in pursuance of

section 11

of the

Ministers and Secretaries Act, 1924

(No. 16 of 1924), and of every and any other power me in this behalf enabling do hereby make the following regulations :—

1.—This Order may be cited as the Army Pensions (Forms of Application) Regulations Order, 1927.

2.—In this Order—

the expression " the Principal Act " means the

Army Pensions Act, 1923

(No. 26 of 1923) and

the expression " the Act of 1927 " means the

Army Pensions Act, 1927

(No. 12 of 1927).

3.—The

Interpretation Act, 1923

(No. 46 of 1923) applies to the interpretation of this Order in like manner as it applies to the interpretation of an Act of the Oireachtas.

4.—(1) Every application under sections 9, 10 or 13 of the Act of 1927 for the grant of a disability pension shall be in the Form No. A.P. 28 in the Schedule hereto and shall contain the particulars asked for or otherwise indicated in that Form.

(2) Every application under section 14 of the Act of 1927 for the grant of an allowance or gratuity in respect of the death of a person shall

(a) if made by the widow of the deceased person on behalf of herself or on behalf of herself and the deceased person's children, be in the Form No. A.P.29 in the Schedule hereto and contain the particulars asked for or otherwise indicated in that Form, and

(b) if made on behalf of the children of the deceased person by a person other than the widow of the deceased person, be in the Form No. A.P.30 in the Schedule hereto and contain the particulars asked for or otherwise indicated in that Form.

(3) Every application under section 14 of the Act of 1927 for the grant of a gratuity in respect of the death of a person made by or on behalf of a dependant (not being the widow or child) of the deceased person shall be in the said Form No. A.P.30 in the Schedule hereto and contain the particulars asked for or otherwise indicated in that Form.

(4) Every application under section 1 of the Principal Act as amended by the Act of 1927 or under section 11 of the Act of 1927 for the grant of a wound pension shall be in the Form No. A.P.31 in the Schedule hereto and shall contain the particulars asked for or otherwise indicated in that Form.

(5) Every application under sub-section (1) of section 15 of the Act of 1927 for the grant of an allowance or gratuity in respect of the death of a person shall—

(a) if made by the widow of the deceased person on behalf of herself or on behalf of herself and the deceased person's children, be in the Form No. A.P.32 in the Schedule hereto and contain the particulars asked for or otherwise indicated in that Form, and

(b) if made on behalf of the children of the deceased person by a person other than the widow of the deceased person, be in the Form No. A.P.33 in the Schedule hereto and contain the particulars asked for or otherwise indicated in that Form, and

(c) if made on behalf of a dependant (not being the widow or a child) of the deceased person, be in the said Form No. A.P.33 of the Schedule hereto and contain the particulars asked for or otherwise indicated in that Form.

6.—Every application under section 12 of the Act of 1927 for the grant of a wound pension shall be in the Form No. A.P.34 in the Schedule hereto and contain the particulars asked for or otherwise indicated in that Form.

7.—Every application under sub-section (2) of section 15 of the Act of 1927 for the grant of an allowance or gratuity shall be in the Form No. A.P.35 in the Schedule hereto and shall contain the particulars asked for or otherwise indicated in that Form.

Made and prescribed in exercise of the powers aforesaid this tenth day of August, 1927.

LIAM T. MACCOSGAIR,

Aire Cosanta Gníomhathach.

(SECOND AND THIRD SCHEDULES.)

A.P. 28.

ARMY PENSIONS ACTS, 1923 AND 1927.

DISABILITY PENSION.

APPLICATION BY A PERSON CLAIMING A DISABILITY PENSION UNDER

SECTIONS 9

,

10

OR

13

OF THE

ARMY PENSIONS ACT, 1927

.

The questions are to be answered in the claimant's own words, and the form is to be signed by him and the signature witnessed. In the event of the claimant being unable to write he should affix his mark, such act being witnessed.

Army No......................................

Rank............................................................ ..............................................

Unit and Corps

............................................................ ............................................................ .......................

Name and Rank of Commanding Officer............................................................ ...............................................

............................................................ ............................................................ .........................................................

Name (To be written in block capitals)

............................................................ ..........................................

(Surname)

(Christian Names)

Rank in

Irish Volunteers

............................................................ .....................................................

Irish Citizen Army, 1916

............................................................ ..........................................

National Army

............................................................ ......................................................

Age last birthday

............................................................ ............................................................ ................

Present Address

............................................................ ............................................................ ......................

Nearest Gárda Síochána Station

............................................................ ......................................................

Note.—Before answering the questions below, the applicant is to note that

(

a

) The statement made by him will be checked from official records. Section 12 (1) of the Act imposes a summary penalty for a false declaration:—" Every person who, with a view to obtaining the grant or payment of a pension, allowance, or gratuity under this Act, either for himself or for any other person, makes, signs, or uses any declaration, application, or other written statement knowing the same to be false, shall be guilty of an offence under this section, and shall be liable on summary conviction thereof to a fine not exceeding twenty-five pounds or, at the discretion of the court, to imprisonment for any term not exceeding six months, or to both such fine and such imprisonment."

(

b

) In answering question 3 any special circumstances involved in his service which, in claimant's opinion, caused any unfitness from which he may be suffering should be clearly stated.

If the applicant is unable to read, the above notes should be read over to him by the witness, who should so testify in his attestation of the claim.