Claim Form

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Claim Forms: Claims in Respect of Deceased Persons

If you are making a claim where NO Grant of Representation has been extracted, please click here

Alternatively

if you are making a claim where a Grant of Representation has issued to you, OR
If you are making a claim and you have received a Certificate entitling you to make a claim on behalf of the estate of a deceased person, then:

Please read the Information Sheet carefully and fill in the Claim Form.

Documents

An Information Sheet relating to the operation of the Scheme
Please read the information sheet before completing the claim application form. You may find that you are not the correct person to make the claim.

Claim Application Form

(N.B.: If you have not already installed Acrobat Reader on your computer, you can download and install from this location.)

Claims in Respect of Deceased Persons where NO Grant of Representation has been extracted

If you are considering making a claim on behalf of a deceased person in whose estate NO Grant of Representation has been extracted, please fill in the form 'Entitlement to Extract a Grant' only.

Documents

Form of Entitlement and Explanatory Notes

Once the Scheme Administrator has issued a certificate to you confirming that you are the person entitled to extract a Grant of Representation, then you must read the Information Sheet carefully and fill out the Claim Forms above

(N.B.: If you have not already installed Acrobat Reader on your computer, you can download and install from this location.)

© HSE Health Repayment Scheme 2006Disclaimer	© Feidhmeannacht na Seirbhíse Sláinte 2006Séanadh
Phone: 1890 886886	Teil: 1890 886886