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Form

WRS - Multiple
Version 02/2007

This form is for use for applications made between 2nd April 2007 and 3rd February 2008

Single Payment for Multiple Worker Registration Applications


Section A: Contact details of the person paying for the applications
1 Title Mr Mrs Miss Ms Other (please state)

2 Contact name

3 House number and street

4 Town

5 County

6 Post code 7 Your reference

Please complete lines 8-12 if details for a refund are different to the contact name and address above.

8 Payee / Company name

9 House number and street

10 Town
11 County

12 Post code

Section B: Summary of applications


13 Total number of applications enclosed (2-25) Minimum 2 and maximum 25 applications

14 How many applications are to be: Paid for Renewal

15 Total amount payable £ Maximum of £2250.00

A separate WRS form must be completed for each applicant. List all applications on page 2

Section C: Payment details – please complete where appropriate


16 Method of payment UK Postal order UK Cheque
Please make payable to: Home Office, Work Permits (UK)

Account No. Sort code Cheque No.

Or please debit my Visa MasterCard Delta Maestro UK

17 Amount paid £ Maximum of £2250.00

18 Name on card

19 Card number

20 Card Valid from / Expiry date /


details
Issue No. CVV No.
(Maestro (UK)) (On rear of card)

21 Signature (card payment only) Date

WRS – Multiple
List all applications on Page 2
Page 1 of 2
Passport

ID Card
Renewal
Paid
Nationality

Latvian
Date of Birth

Estonian

Polish
Czech

Slovakian
Hungarian

Lithuanian

Slovenian
Surname/Family Name of Employer
Name in the UK
Application
type
Enclosed D D M M Y Y Y Y
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

NOW COMPLETE PAGES 2 – 4 OF THE WRS FORM FOR EACH APPLICANT

WRS – Multiple Page 2 of 2