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Or cohabiting, from what date? Part 2 Widowed Remarried Married 12.Are you? Cohabiting Separated Divorced D D M M Y Y Y Y Please attach your Marriage Certificate if married outside the Republic of Ireland. Your work and claim details 14.If you are retired or intend to retire between age of 65 and 66, please state: Date of retirement from employment and/or selfemployment: D D M M Y Y Y Y 15. If you worked in Ireland before 1979, fill in your Social Insurance number or addresses yo.

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