Form 49 - Notice Of Application Under S. 9(2)(C) Health (Repayment Scheme) Act 2006

What this form is for

• • Use this form when applying for repayment under the Health (Repayment Scheme) Act 2006
• • Use this form if you believe you're entitled to repayment for health-related costs
• • Use this form for applications specifically under Section 9(2)(C) of the Act
• • Use this form when you have supporting documentation for your claim
• • Use this form when the repayment relates to health services provided in Ireland

Use this form or another form?

Deadline or filing window

Applications should generally be submitted within 12 months of the health service provision or as specified in your particular case. Late applications may be considered only in exceptional circumstances.

Before you submit

• • All sections of the form completed
• • Supporting documentation attached
• • Personal details verified
• • Claim amount calculated correctly
• • Form signed where required
• • Copy retained for personal records
• • Check payment requirements if applicable

How to file this form

1. 1Obtain the current Form 49 from the Courts Service website
2. 2Complete all sections with accurate information
3. 3Gather supporting documentation for your claim
4. 4Submit the completed form through the appropriate channel
5. 5Keep a copy of your submission and any receipt
6. 6Follow up if you don't receive acknowledgment within the expected timeframe

Known limitations

• • This form only applies to claims under Section 9(2)(C) of the Health (Repayment Scheme) Act 2006
• • The Courts Service may not accept applications outside their jurisdiction
• • Certain health repayment claims may require additional forms
• • The form may not be suitable for emergency health cost repayments
• • Processing times may vary depending on case complexity