Skip to content
Review Request Form
Review Request Form
DC
2026-04-16T10:29:29+01:00
"
*
" indicates required fields
1
2
3
1. Applicant Information
Full Name
*
Date of Birth
*
DD slash MM slash YYYY
Person ID Number
*
Current Address / Specified Place
*
Phone Number
*
Email Address
*
Enter Email
Confirm Email
Do you have any dependants you would like to include in your request?
*
Please select...
Yes
No
List all dependents included in your application
Person ID Number
First Name(s)
Surname(s)
Actions
Edit
Delete
There are no
Dependants.
Add Dependant
Maximum number of dependants reached.
Confirm Type of Request
*
Please select...
Request a review of a Restriction to Freedom of Movement applied to you (section 108)
Request to change/amend a Restriction to Freedom of Movement applied to you (section 107(2))
Request to change/amend an Alternative to Detention requirement applied to you (section 116(2))
Review of Age Assessment Decision
2. Grounds of Request
Date the requirement/decision was notified to you
*
DD slash MM slash YYYY
Issuing Authority
*
Please select...
Immigration Officer
Minister’s Officer
Garda
Requirement Type
*
Please select...
Live at a specific address or place (not in detention)
Report to immigration or Garda at set times or regularly
Attend or stay at a specific place for up to 12 hours total (for example, to attend an appointment or interview related to your application)
Other (please describe):
Requirement Type
*
Please select...
Live at a specific address or place (not in detention)
Report to immigration or Garda at set times or regularly
Other (please describe):
Other Requirement Type
*
Grounds of Review Request
*
Request under Section 110 to reside temporarily outside the specified place
*
Please select...
Yes
No
Grounds for Request under Section 110
*
Supporting Documents
*
3. Declaration and Signature
Consent
*
I agree to the below.
I declare that all information and documents that I have provided, and all statements that I have made are true to the best of my knowledge and belief, and that I have made these statements freely and voluntarily. I declare the truth of this application by ticking this box.
Signature
*
Date
DD slash MM slash YYYY
Time to Complete
Page load link
Go to Top
