S.I. No. 387/1952 - Unemployment Assistance (Application For Assistance Regulations) (Amendment) (No. 2) Order, 1952.

1. Particulars of children :—

NAME OF CHILD

Date of Birth

Relationship to you.

SURNAME

CHRISTIAN NAMES

Day

Month

Year

(1)

(2)

(3)

(4)

(6)

(7)

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

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

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

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

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

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

2. Are you in receipt of Children's Allowances ? If so, state Claim Number shown on your Allowance Book............................................................ ............................................................ ............................................

3. State total number of children under 16 years of age in your household....................................................

4. Is any allowance (other than a Children's Allowance), benefit, pension or assistance payable, either to you or to any other person, in respect of any child who is in your household or who normally belongs to your household ? If so, give particulars............................................................ .......................

DECLARATION

I hereby declare that, to the best of my knowledge and belief, all the information given by me on this form in respect of persons claimed as my dependants is true in all respects and no other person is claiming any increase of benefit or assistance in respect of any of these persons. I undertake to notify the Local Officer of the Department of Social Welfare if any of the information furnished by me on this form ceases to be true.

*Signature ............................................Date............................................................ ......................

Signature and Address of Witness to Mark

}

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

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

*If you are unable to write, your mark should be affixed and duly witnessed.

CONFIRMATION (See Note below)

The information given in this claim is correct to the best of my knowledge and belief.

Date............................................................ .................Signature............................................................ ........................

Address............................................................ ...........Description............................................................ .....................

Note.—The confirmation should be signed by one of the following : A Peace Commissioner ; a Barrister or Solicitor ; a Minister of Religion ; a Registered Medical Practitioner ; a Schoolmaster or Teacher of a day school ; a Home Assistance Officer ; a County, City, Borough or Urban District Councillor ; a Secretary or other responsible local representative of the Claimant's Trade Union.

Given under the Official Seal of the Minister for Social Welfare, this 31st day of December, 1952.

(Signed) W. MAGUIRE,

Secretary,

Department of Social Welfare.

A person authorised under

Section 15

(1) of the

Ministers and Secretaries Act, 1924

, to authenticate the Seal of the said Minister.

5. Is she single, married or a widow ?............................................................ .......................................................

6. Is she wholly or mainly maintained by you?............................................................ ............................................................ ............................................

7. What weekly wages do you pay her ?............................................................ ..................................................

8. If she is claiming or in receipt of any benefit, pension, allowance or assistance, give particulars............................................................ ............................................................ ..................................

D. PERSON claiming as dependants A CHILD OR TWO CHILDREN under 16 years of age

S.I. No. 387 of 1952.

UNEMPLOYMENT ASSISTANCE (APPLICATION FOR ASSISTANCE REGULATIONS) (AMENDMENT) (NO. 2) ORDER, 1952.

The Minister for Social Welfare, in exercise of the powers conferred on him by subsection (1) of

section 7

of the

Unemployment Assistance Act, 1933

(No. 46 of 1933), as adapted by the Social Welfare (Transfer of Departmental Administration and Ministerial Functions) (No. 1) Order, 1947 (S. R. & O., No. 18 of 1947), hereby orders as follows