6.

PPS Number: *

1110550SA

7. Do you currently work with Derrycourt Cleaning Specialists? *

Yes

No

8. Please enter your IBAN: *

IE32BOFI90042042373534

9. Please enter your BIC: *

BOFIIE2DXXX

10. DECLARATION: I have read and I understand the guidelines for this payment,
and I understand that all payments are subject to audit and review, and:
*

I am entitled to the Pandemic Special Recognition Payment (PSRP).

I have not previously received a PRSP and I understand that as only one pay-
ment per person is allowed, I will have to refund this payment to Derrycourt if it
is found to be a duplicate.

I authorise Derrycourt Cleaning Specialists to process my application for

PRSP.

I authorise Derrycourt Cleaning Specialists to make this payment into the bank
account that is registered in my name at Derrycourt, or provided on this form.
:
 account that is registered in my name at Derrycourt, or provided on this form.

11. By submitting this form, I understand that I am digitally signing and dating this
application.
*

Yes

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