Social Welfare Illness Certification

Social Welfare Illness Certification
The Department of Employment Affairs and Social Protection (DEASP) provides illness benefit if you cannot work because you are sick or ill. In order to claim the benefit, you must obtain a medical certificate called a ‘Certificate of Incapacity for Work’ from your GP The certificate will be submitted electronically through a secure online system by your GP. An IB1 form must be submitted by the patient simultaneously.

More information can be found on the following links:
An employer may also require a separate medical certificate if you are out sick for more than 2 or 3 consecutive days. Initial certification for each new episode of sick leave requires a consultation with the GP. Certificate extension may be requested by submitting the form below. We will contact you if you need to be reviewed by a GP.
Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Start date for certificate*

DayMonthYear
Start Date
End date for certificate*

DayMonthYear
End Date
Reason for certificate*
I require a*

Social Welfare Illness Certification
Is this request to extend a previously provided social welfare certificate?*

Yes I wish to extend my previously provided social welfare certificate.
Reminder: A new consultation is needed with one of our GPs for each new episode of sick leave requires a consultation with the GP.
Consent*

I consent to this message being sent electronically to the practice.
Should be Empty: