Please provide full details of your household income by completing all sections of the following form.
Alternatively you can download, print and complete a PDF version of this form and post it back into us. Download Form.
This form may require a number of documents to be uploaded depending on your individual circumstances. These documents can be either digitally photographed using a camera or camera-phone, or you can scan them in.
To find out what documents you will need to photograph/scan and upload before starting the form process, please choose from the options below:
If you, or any member of your household, are in receipt of a welfare payment you must either:
Once you have either your completed and signed printed PDF form from the Social Welfare Office or the statement you received in the post from your online Social Welfare website request, you can photograph either of them and upload them in section 3 of the form.
You will also need to photograph and upload photographs of 3 current social welfare slips in section 3 of the form.
You will need to upload a photograph of a current P60 or 3 current pay slips for each employed person in your household.
You will need to upload a photograph/s of a the most recent tax returns or set of accounts for each self-employed person in your household.
You will need to upload a photograph of a current P45 for each unemployed person in your household.
You will need to upload a photograph of a letter confirming pay and attendance at CE Scheme for each person in your household that is on a CE programme.
If you or anyone in your household is currently in receipt of a private, occupational or foreign pension, you will need to upload a photograph of an up to date statement from your pension provider to confirm the total amount received.
If you, or any member of your household, are in receipt of an Irish State Pension you must either:
For each person in your household (aged over 18) and in full time education, you will need to upload a photograph of a letter from the School or College confirming their attendance.
Please upload a photograph of relevant documentation if you or a member of your household has earned interest on savings, dividends on shares or received any other income with a value greater than €100 in the past year.
If you have photographs or PDFs of the requested list of documents above, please click on the NEXT button below.
If you don't have all the listed documents, you won't be able to complete the following form. Please obtain the items in the list and come back to this form when you have everything ready.
Please list all members of the household, including all children and dependents in this section. If there have been
new additions to your household, please include.
Maximum number of members reached.
Maximum number of contacts reached.
Failure to provide your full household income or information requested will result in the application of
penalties as per your tenancy agreement.
Failure to provide the necessary documentation to establish income levels represents a breach of tenancy agreement and could jeopardise your tenancy with Circle VHA.
Maximum number of people reached.
Maximum number of sources reached.
If you or a member of your household has earned interest on savings, dividends on shares or received any other income with a value greater than €100 in the past year, please enter the amount below:
You will upload documents, relevant to the above, in the next section.
Based on the answers you submitted at the start of the form in the 'Preparation Checklist', you will need to upload the following documents:
Use this to upload photographs, scans or pdf's of your requested documents.
I/We declare that the income details as provided are a full and an up to date accurate statement of my/our household income.
I/We authorise and give authorisation for Circle Voluntary Housing Association to seek and receive any information which Circle Voluntary Housing Association may require from my/our employer or The Department of Social Protection or from any source in relation to income.
I/We are aware that it is a condition of my/our tenancy agreement that the inclusion of false information or omission of any income details is a breach of my/our tenancy agreement and may jeopardise my/our tenancy with Circle Voluntary Housing Association.
Circle VHA, Phoenix House, 32-34 Castle Street, Dublin 2, Ireland.