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Leap Card Replacement Application Form Please complete this form in BLOCK CAPITALS (*) = required

Leap Card Replacement

Application Form

Please complete this form in BLOCK CAPITALS (*) = required field

Completed applications should be sent to:

Leap Card Customer Care, PO BOX 12119, Dublin 24

1. Cardholder's Personal Details First Name * Surname * Date of Birth * d d
1. Cardholder's Personal Details
First Name *
Surname *
Date of Birth *
d
d
m
m
y
y
y
y
2. Cardholder's Contact Details Address 1 * Town * Address 2 Post code (if in
2. Cardholder's Contact Details
Address 1 *
Town *
Address 2
Post code
(if in Dublin) *
Address 3
County *
Phone
Email
3. Leap Card Details Leap Card number (first 10 digits) * Leap Card is Registered
3. Leap Card Details
Leap Card number (first 10 digits) *
Leap Card is Registered on leapcard.ie
Leap Card is Personalised (has the cardholder's
name and photo printed on it)
4. Reason for Replacement Request Leap Card lost/stolen Leap Card failed due to no fault
4. Reason for Replacement Request
Leap Card lost/stolen
Leap Card failed due to no fault of the cardholder
(Important: Please attach the faulty card with this
form!)
5. Signature Leap Card holder's signature * Date * d d m m y y
5. Signature
Leap Card
holder's
signature *
Date *
d
d
m
m
y
y
y
y

What next? Complete Applications: If your application is complete you will receive your replacement Leap Card at the postal address you provided within 10 working days. Incomplete Applications: If your application is incomplete, your application and card will be returned to you within 10 working days.

Determination of Replacement Value:

All replacements issued are subject to Leap Card Terms and Conditions and the refund policies
All replacements issued are subject to Leap Card Terms and Conditions and the refund policies of the individual Transport Operators.
Our determination of value shall be final.
For office use only:
Replacement ID
Immediate Replacement
Deferred Replacement
If approved state the new Leap Card number
Replacement Approved
Replacement Declined
If declined state
the reason

LCRP 131011