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Apply for Free Travel if you are medically certified unfit to drive (FTM)

This topic helps you fill in the FTM. Free Travel for people medically certified unfit to drive application form.

Use this topic if you or someone you support:
  • Is Between 17 and 66 years of age, and
  • Has been or is expected to be medically certified unfit to drive for at least 12 months, and
  • Has been told to complete the FTM form by the Free Travel Section, your GP or a support worker

Tip

If you are not sure this is the right form, you can go back to:

Before you begin

The FTM form has 4 parts. You fill in Parts 1 and 2. Your doctor fills in Parts 3 and 4.

Steps

Open each step below to see:

  • Who completes that part
  • What information to write
  • Any extra actions to take
1. Fill in Part 1 . Your details

This section is about you, the person applying.

Question 1. PPS Number

  • Carefully copy your PPS Number from your Public Services Card, payment letter or Revenue document.
  • Write one number per box.

Question 2. Title

  • Put an X in the box for Mr, Mrs, Ms, or
  • Write another title in the “Other” box if you use a different title.

Question 3. Surname

  • Write your current family name in capital letters.
  • Use one letter per box.

Question 4. First names

  • Write your first name and any middle names as they appear on your birth certificate or passport.
  • Use capital letters.

Question 5. Birth surname

  • If your surname is different from the surname you were born with, write your birth surname here.
  • If it is the same, repeat your surname.

Question 6. Date of birth

  • Fill in the day, month and year using the small boxes.
  • Example. 03 07 1975.

Question 7. Address

  • Write your home address in Ireland, one line per row.
  • Include your county and Eircode if you know it.

Question 8. Telephone number

  • Give a phone number where the department can contact you or leave a message.
  • Include the area code for landlines.

Question 9. Email address

  • If you have email, write it clearly in the boxes.
  • If you do not use email, leave this blank.

When you are finished, check that all boxes in Part 1 are filled in correctly before you move on.

2. Sign Part 2 . Declaration

Part 2 is a legal declaration about the information you have given.

By signing Part 2 you confirm that:

  • The information you give is true and complete.
  • You are legally resident and living permanently in the State.
  • You will tell the department about any change in your circumstances that may affect your entitlement.

You must:

  1. Sign your name, or make a mark if you are unable to sign.
  2. Write the date.
  3. Ask a witness to sign and date if you cannot sign yourself.

Make sure Part 2 is signed and dated before the form is sent.

3. Ask your doctor to complete Part 3 . Medical report

Part 3 is completed by your doctor. You cannot fill this in yourself.

The note at the top explains that any fee for completing this medical report must be paid by you, the applicant.

Your doctor is asked:

  1. How long you have been their patient

  2. They enter the date you first attended their practice as a patient.

  3. Whether you are unfit to drive due to a medical condition

  4. They tick Yes or No.
  5. If they tick No, they go straight to Part 4.

  6. If they tick Yes, they also answer Question 3.

  7. How long you are expected to be medically unfit to drive

  8. They tick one box to show their professional opinion.
    • Less than 1 year
    • 1 to 2 years
    • 3 to 5 years
    • Greater than 5 years

You should check that your doctor has ticked the correct boxes and answered all questions in Part 3.

4. Ask your doctor to complete Part 4 . Doctor’s details

Part 4 collects your doctor’s contact details and confirmation.

Your doctor must fill in:

  • Doctor’s name
  • IMC number
  • Address, including
  • Street address
  • County
  • Eircode if available

They must also provide:

  • Doctor’s signature . not in capital letters.
  • The date they signed the report.
  • Their official stamp in the box provided.

Before you leave the surgery, check that:

  • All address lines are filled in.
  • The doctor has signed and dated the form.
  • The official stamp is clearly shown.

At the bottom of the page there is a Data Protection Statement explaining how your information is used and protected by the Department of Social Protection.

Where to send the completed form

Before you post

When all relevant parts are filled in, quickly check that:

  1. Every question that applies to you has been answered
  2. Any supporting documents mentioned in the form are attached
  3. You have signed the Declaration in Part 2
  4. A witness has signed Part 2 if you needed a witness.
  5. Your doctor has completed Part 3 and Part 4, signed both sections where needed and added the official stamp.
  6. You have kept a copy or clear photos of the form, if you can.

If an official reply envelope came with the form, use that envelope.

Postal address for FTM

Free Travel Section
Department of Social Protection
Social Welfare Services
College Road
Sligo
F91 T384

If your own FT U/70 form shows a different address, always use the address printed on your form.

If you need help

If you need help to complete the form, you or a support person can:

  • Bring the form to a Citizens Information Centre or Intreo Centre and ask staff to talk through it with you.

  • Or contact the Free Travel Section by:

    • Email. freetravelqueries@welfare.ie
    • Phone. 0818 200 400 or 071 915 7100