Application form for
Over 70 Companion
Free Travel
Social Welfare Services
FT O/70
Data Classification
Confidential R
How to complete this application form?
There is an example on the back of this page that can be used as a guide to ll in this form;
• Write with a black ballpoint pen, use capital letters and place an X in the relevant boxes; and
• Complete Part 1 and Part 2 of this form and sign and date the declaration.
Note: You will need your Personal Public Services (PPS) number to complete this form.
What is Over 70 Companion Free Travel?
If you are 70 years of age or over and in receipt of Free Travel but are unable to travel alone due to a
medical condition, you may be allowed to have a companion aged 16 years or over to travel with you for
free.
If you are not in receipt of Free Travel, please also ll out the Free Travel (FT1) registration form available
from www.gov.ie/FT1 or your local Intreo Centre. However, you cannot avail of Free Travel if you do not
have a Public Services Card (PSC). To get a PSC, please book an appointment at your local Intreo Centre,
details of which can be found at www.gov.ie/intreocentres.
If you already have a Public Services Card with Companion Free Travel and it is lost, stolen or damaged,
please phone 0818 837 000 to request a replacement - do not complete this form.
How do I apply?
Send this completed form to:
Free Travel Section
Department of Social Protection
Social Welfare Services
College Road
Sligo
F91 T384
How do I get help and further information?
If you need any help to complete this form, please contact the Free Travel section by email at
Your local Intreo Centre, Social Welfare Oce or any Citizens Information Centre can also help. You can
nd the name and address of your local Intreo Centre or Social Welfare Oce by visiting
www.gov.ie/intreocentres.
For more information, visit www.gov.ie/FreeTravelScheme.
Your detailsPart 1
To help us process your review please write letters and numbers clearly and use one box
for each. See examples below.
How to ll in this review form
SAMPLE
1. PPS Number:
2. Surname:
4. Date of birth:
3. First names:
1 2 3 4 5 6 7 T
M U R P H Y
M A U R E E N
D D M M Y Y Y Y
2 8 0 2 1 9 4 8
1 N E W S T R E E T
O L D T O W N
D O N E G A L T O W N
5. Address:
6. Telephone number:
0 8 8 1 2 3 4 5 6 7
County
D O N E G A L
C 1 5 A 9 6 V
M M U R P H Y @ W E L F A R E . I E
7. Email address:
Eircode
Page 1
Your detailsPart 1
1. PPS Number:
2. Surname:
4. Date of birth:
3. First names:
D D M M Y Y Y Y
5. Address:
6. Telephone number:
County
7. Email address:
Eircode
Your medical conditionsPart 2
8. Are you unfit to travel alone due to a medical condition?
Application form for
Over 70 Companion
Free Travel
Social Welfare Services
FT O/70
Data Classification
Confidential R
Yes No
Signature or mark if unable to sign, not capital letters.
Date:
D D M M Y Y Y Y
2 0
Signature of witness, not capital letters.
Date:
D D M M Y Y Y Y
2 0
If you are unable to sign, have your mark witnessed and have the witness sign below.
Warning: If you make a false statement or withhold information, you may be prosecuted leading to a fine,
a prison term or both.
I declare that all the information I have given on this form is truthful, accurate and complete, and that I am
legally resident and living permanently in the State. I understand that if any of the information I provide is
untrue or misleading or if I fail to disclose any relevant information, I will be required to repay any benet I
receive from the department and that I may be prosecuted. I undertake to immediately advise the department
of any change in my circumstances which may aect my continued entitlement.
Declaration
If yes, please confirm your medical conditions that make you unfit to travel alone:
Page 2
00K 07-24 Edition: July 2024
Explanations and terms used in this form are intended as a guide only and are not a legal interpretation.
Data Protection Statement
The Department of Social Protection administers Ireland’s social protection system. Customers are required
to provide personal data to determine eligibility for relevant payments and benefits. Personal data may
be exchanged with other government departments and agencies where provided for by law. Our data
protection policy is available at www.gov.ie/dsp/privacystatement or in hard copy.
