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Apply for Under 70 Companion Free Travel (FT U/70)

This topic helps you fill in the FT U/70. Under 70 Companion Free Travel application form.

Use this topic if you or someone you support:
  • Is under 70 years of age, and
  • Is already in receipt of Free Travel, but
  • Cannot safely travel alone and need a companion aged 16 or over to travel with you, and
  • Have been told to complete the FT U/70 form by the Free Travel Section, your doctor or a support worker

Tip

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

Before you begin

The FT U/70 form has 4 parts.

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 and declaration

Part 1 is about you, the person applying. It also includes a declaration that you must sign.

Your details

Fill in each question carefully, using capital letters and putting one character in each box.

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. Surname

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

Question 3. First names

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

Question 4. Date of birth

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

Question 5. Address

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

Question 6. Telephone number

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

Question 7. Email address

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

Declaration in Part 1

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

By signing Part 1 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 1 is signed and dated before the form is sent.

2. Sign Part 2. Permission to release medical information

Part 2 is headed Permission to release medical information.

By signing here, you give your doctor permission to give the Department of Social Protection the medical information needed to assess your application for Under 70 Companion Free Travel.

The text explains that:

  • Your medical information will be reviewed by one of the department’s Medical Assessors
  • It will be treated in strict confidence
  • After you sign this part, you should give the form to your doctor so they can complete Part 3

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.

You do not need to send any medical reports yourself. Your doctor will send the medical information after you sign this permission. Do not ask your doctor to complete Part 3 until Part 2 is signed and dated.

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

Part 3 is a medical report. It is completed by your doctor, not by you.

It is longer than the other parts because it gives the department’s Medical Assessor a full picture of your health and how it affects your ability to travel alone.

The front of Part 3 explains to your doctor that:

  • The report is only for people under 70 years of age
  • The information will be reviewed by the department’s Medical Assessors
  • It will be handled in strict confidence
  • The doctor can claim a special fee for completing and returning the report

What your doctor fills in

The report asks your doctor to record:

  • Your basic details: name, PPS Number, date of birth, contact details
  • Your diagnosis, medical history and any surgery or treatment
  • Recent hospital admissions, tests and investigation results
  • How long they expect your condition to last
  • How your condition affects daily activities such as walking, balance, vision or learning

At the end of Part 3 and in the Doctor’s details section they must:

  • Enter their panel number and IMC number
  • Sign and date the form
  • Add their official stamp

What you or your supporter should do

  • Bring the form to a doctor who knows your medical history, along with any hospital letters if you have them
  • Before you leave the surgery, check that all pages of Part 3 are completed, and that the doctor has signed, dated and stamped the form
4. Use Part 4 . Checklist before you send the form

Part 4 is a checklist and a section for official use only.

Checklist for you and your doctor

Use this part as a final checklist before you post the form. You are asked to answer Yes or No to these questions:

  1. Are you in receipt of Free Travel?
  2. If no, have you also completed the Free Travel (FT1) registration form available from www.gov.ie/FT1 or your local Intreo Centre?
  3. Have you signed the declaration in Part 1?
  4. Have you signed Part 2 to allow your doctor to share your medical information with the Department of Social Protection?
  5. Has your doctor completed and stamped Part 3?

Tick Yes only when each step is complete. Ask your doctor or support person to help you fix anything that is not yet done.

For official use only

This section is completed by the department, not by you.

It explains that Under 70 Companion Free Travel will be awarded if the claimant is considered medically unfit to travel unaccompanied. The official completing the form will tick whether the applicant is:

  • Suitable
  • Not suitable
  • More medical evidence required

They then add their signature and date.

You do not need to fill in this part, but it is helpful to know what it is for.

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 1
  4. A witness has signed Part 1 if you needed a witness.
  5. Your doctor has completed and signed all pages of Part 3, including their official stamp.
  6. You have gone through the checklist in Part 4 and ticked the boxes that apply
  7. 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 FT U/70

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