Sample Application Forms

Applicant No 1: Ms. Anne Other

The applicant signs the form herself as she has capacity to make decisions and understands the scheme.

Their financial assessment will also include the value of a property that was transferred to their daughter in 2015.

The couple apply for the nursing home loan (ancillary State support) in respect of their principal residence as they have a low level of income and savings at their disposal.

Anne's sample application form

Applicant No. 2: Mr. John Kavanagh

He owns his own home and his daughter Anne lives with him.  He has a low level of income and a small sum of savings at his disposal.

His daughter has been appointed as his Care Representative for the purpose of making the application.  The appointment of a care representative is required in this case as Mr. Kavanagh needs to avail of the nursing home loan.

The applicant’s daughter Anne signs the application form in Sections 2, 5 and 6 as her father’s Care Representative.

John's sample application form

Applicant No. 3: Ms. Mary Murphy

She owns her own home. 

The applicant is unable to sign the form herself as she has reduced capacity to make decisions or to understand the scheme.

As the nursing home loan is not required a legally appointed representative is not required in this case.

Mary's sample application form