Get Security Certificate Requisition Form - Hse

Filling out the Security Certificate Requisition Form - HSE is an essential step for primary care contractors seeking to authenticate their electronic communications with the Primary Care Reimbursement Service. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Security Certificate Requisition Form

1. Click ‘Get Form’ button to access the form and open it in the designated editor.
2. In Part 1, select the type of requisition you are making. Choose between 'Additional,' 'Replacement,' 'Standard,' or 'Emergency.' If selecting 'Emergency,' provide a clear reason for the expedited request.
3. Proceed to Part 2 where you will enter your Applicant’s Details. Fill in your PCC Number, Trading Name, First Name, Surname, Phone Number, Mobile Number, Fax Number, IDC Number, VAT Number, and E-mail Address. Ensure that the Mobile Number is completed as it is mandatory.
4. For verification, include the PCC Stamp and the PCC Address in the designated sections.
5. In Part 3, read the Declaration carefully. Sign and date the form, ensuring you comply with all responsibilities outlined regarding security and data protection.
6. Once completed and signed, scan the document and email it to cert.info@hse.ie, or post it to the specified address. Note that faxed forms are not accepted.

Complete your Security Certificate Requisition Form online today to ensure timely processing.