E104 Form PDF

REQUEST FOR IRISH SOCIAL INSURANCE RECORDS PER FORMS E104 AND E301 IRL. INFORMATION REQUIRED BLOCK CAPITALS PLEASE Form Required E301 E104 Full Name What is your Personal Public Service Number PPS No. same as RSI or Tax Number Nationality What is your date of birth Day Month Year Date of intended departure from Ireland Date of entry to Ireland Forwarding Address. Irish Address. Contact Phone Number. Details of Irish Employers Name Address Nature of Employment/Job Title From To Items Required P45 forms in respect of client s employment or employments in the current tax year. P60 forms from the previous tax year Photocopies of the P45/P60 are acceptable as long as the information is clearly visible Note The more documents supplied by the client the easier it is to issue the E104 and E301 IRL Forms. Nevertheless in many cases the forms can only be issued following enquiries with client s former employers. These enquiries can take some weeks to complete. Unfortunately the resulting delays in supplying the E104 and E301 IRL forms are beyond our control* If the client is claiming Jobseeker s Benefit or Allowance the forms E104 and E301 cannot be issued until he or she has stopped claiming. Applications must be posted to DEPARTMENT OF SOCIAL AND FAMILY AFFAIRS Client Eligibility Services Short Term Value Stream Inner Relief Road Buncrana Co. Donegal Ireland Please note as the above office is not a public office applications must be sent by post only. Your PPS Number must be quoted with all enquiries. Explanation of forms The E301 form is a certificate showing periods of social insurance for the purpose of claiming unemployment benefit in another country covered by EC Regulations claiming sickness/maternity/invalidity benefit or bereavement/death grant in another country covered by EC Regulations. Irish Address. Contact Phone Number. Details of Irish Employers Name Address Nature of Employment/Job Title From To Items Required P45 forms in respect of client s employment or employments in the current tax year. P60 forms from the previous tax year Photocopies of the P45/P60 are acceptable as long as the information is clearly visible Note The more documents supplied by the client the easier it is to issue the E104 and E301 IRL Forms. P60 forms from the previous tax year Photocopies of the P45/P60 are acceptable as long as the information is clearly visible Note The more documents supplied by the client the easier it is to issue the E104 and E301 IRL Forms. Nevertheless in many cases the forms can only be issued following enquiries with client s former employers. Nevertheless in many cases the forms can only be issued following enquiries with client s former employers. These enquiries can take some weeks to complete. Unfortunately the resulting delays in supplying the E104 and E301 IRL forms are beyond our control* If the client is claiming Jobseeker s Benefit or Allowance the forms E104 and E301 cannot be issued until he or she has stopped claiming. These enquiries can take some weeks to complete. Unfortunately the resulting delays in supplying the E104 and E301 IRL forms are beyond our control* If the client is claiming Jobseeker s Benefit or Allowance the forms E104 and E301 cannot be issued until he or she has stopped claiming. Applications must be posted to DEPARTMENT OF SOCIAL AND FAMILY AFFAIRS Client Eligibility Services Short Term Value Stream Inner Relief Road Buncrana Co.