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 m m y y y y

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 on leapcard.ie Leap Card is Personalised (has the cardholder's
name and photo printed on it)

4. Reason for Replacement Request 5. Signature

Leap Card lost/stolen Leap Card

holder's
Leap Card failed due to no fault of the cardholder signature *
(Important: Please attach the faulty card with this
form!) 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 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