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EEA(PR

)
Version 04/2015

Application for a document certifying
permanent residence or permanent
residence card under the EEA Regulations
This form is to be used for applications made on or after 6 April 2015
Who this form is for
Use this application form if you wish to apply for a document certifying permanent residence
(if you’re an EEA national) or permanent residence card (if you’re a non-EEA national) as
confirmation of a right of permanent residence under the Immigration (European Economic
Area) Regulations 2006 (‘the EEA Regulations’).
Any reference on this form to EEA nationals includes Swiss nationals.

Eligibility
You must normally have lived in the UK for a continuous period of five years as:
• an EEA national ‘qualified person’ (worker, self-employed, self-sufficient, student or
jobseeker),
• a family member or extended family member* of an EEA national qualified person or
permanent resident,
• a former family member of an EEA national if you’ve retained your right of residence after
the EEA national died or left the UK, or your/their marriage or civil partnership ended in
divorce, annulment or dissolution, or
• a family member of a British citizen who worked or was self-employed in another EEA state
before returning to the UK (‘Surinder Singh’ cases).
You can also qualify if you are:
• an EEA national former worker or self-employed person who has ceased activity in the UK
because you have retired, are permanently incapacitated, or you’re now working or selfemployed in another EEA state but still retain your residence in the UK,
• the family member or extended family member* of an EEA national who has ceased
activity, or
• the family member or extended family member* of an EEA national former worker or selfemployed person who has died.

*You can only apply as an extended family member if you’ve held valid residence documentation
(registration certificate, residence card, or EEA family permit) throughout the relevant qualifying
period.

Replace or renew your permanent residence document
You can also use this form if you have previously been issued with a document certifying
permanent residence or permanent residence card (or equivalent document) and want to replace
it because it has been permanently lost or stolen, or renew it because it has expired.

The fee
There is a fee of £65 for each person applying for a document certifying permanent residence or
permanent residence card. If you do not pay the fee, your application will be invalid and returned
to you without consideration. See the payment guidance notes, enclosed with this form, for
further information.
This form is designed for one applicant only. If you have a partner or other family members who
wish to apply, they must each complete their own form and pay the specified application fee.

Biometric information for non-EEA nationals
If you are a non-EEA national applying for a permanent residence card, you must give your
biometric information (fingerprints and a digital photograph) before your application will be
considered. If you do not, we may reject your application.
See pages 7-12 of this form for further information.

Completing the application form
Complete all relevant sections of the form as directed. Use a black pen and write names,
addresses and similar details in capital letters. In sections where you are asked to give your
personal details and address, leave a space between each name and each part of the address.
You must also send the relevant evidence as specified in section 18 of this form.
Only complete the sections of the form that are relevant to you. If a section does not apply to
you, leave it blank.
To save paper, postage and storage costs, we recommend that you only print and send us the:
• front page of the form, and
• sections of the form that you have actually completed (including the payment section and, if
required, the biometric section).

Where to send your completed application
You cannot apply in person at our Premium Service Centres.
You must send your completed application form, supporting documents, and payment of £65 to
the address below:
Home Office – EEA applications
PO Box 590
Durham
DH99 1AD
Sending it to any other address will delay your application.
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Payment Guidance
The Fee
There is a fee of £65 for this application.
Please note that your application will be rejected as invalid if you do not pay the specified fee.

How you can pay
You can pay by any of the following methods:
• Cheque/Bankers Draft
• Postal Order
• Credit card - Mastercard, Visa (including Electron) or American Express (Amex)
• Debit card - Delta, Maestro* (including Solo)
* Maestro - We can accept only Maestro cards issued in the UK.
Please note that when making large or multiple payments using your credit card, the anti-fraud
measures that banks operate sometimes stop the full payment being taken. This can happen for
a number of reasons. To prevent this you may inform your bank of your intention to make large
or multiple payments in advance so that your bank allows the full payment to be taken when you
submit your application. Please be aware that not all banks offer this service.

Cheques and postal orders
You must make the cheque or postal order payable to ‘Home Office’ and cross the cheque or
postal order A/C Payee only. Please write the full name and date of birth of the applicant on the
back of the cheque and/or each postal order and keep the postal order receipt(s). Please make
sure that the date and the amount (words and figures) are correct and that the cheque is signed
properly. Attach your cheque or postal order(s) to the front of the application form.

Completing the payment details page
To ensure that your payment is processed without any delay, please follow this guidance when
completing the Payment Details section.
1-2
The address at 1 should be the contact address in the UK for any correspondence. If it is
not your home address (eg a solicitor or other authorised immigration adviser may be submitting
the application), give the contact name at 2.
3 This should be the full name of the main applicant as given in his or her passport or travel
document.
4 Date of birth - for example, 3 January 1980 should be written 03 01 1980 in the spaces
provided.
5 If you do not select a fee then we cannot take a payment and your application will be rejected
as invalid.

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we cannot take the payment and your application will be rejected as invalid. AMERICAN EXPRESS AUTHORISED SIGNATURE 4567 123 CVV 123 CVV 1234 1234 123456 12345 1234 Consideration process • If the payment submitted does not cover the full cost of your application. EEA(PR) . If you do not provide the CVV number. This fee will be payable once the application form is received by the Home Office or its payment processing agent.this is the long number across the centre of the card 11 The card security number is a three-digit security code known as the card verification value (CVV). together with any documentation submitted. it will be an invalid application and the form. We allow 5 working days for payments made by cheque to clear.Version 04/15 Page 4 of 127 .9 The name as displayed on the credit/debit card 10 Card number . It consists of the last three numbers on the signature strip on the back of the card as shown below. • The fee charged is for the processing and consideration of the application. • We cannot begin the consideration process until the payment has cleared. credit/debit cards and postal orders will clear immediately.the person named on the credit/debit card must sign and date these sections. 12 Cardholder’s signature . regardless of the outcome of the application. will be returned to you. For Amex the security code consists of 4 digits and is found on the front of the card.

Contact address in the UK for correspondence Postcode 2. If no fee is ticked we cannot take a payment and your application will be rejected as invalid. Paying by cheque/bankers draft . If it is not complete.Version 04/15 Page 5 of 127 . Name on card 10. Amount to pay . Card details Valid from / Expiry date / 12. Cardholders signature CVV number Issue No. Card number 11.please tick the amount you are paying. How are you paying? Please tick a box. the application will be invalid and will be returned to you. Postal order Cheque Debit or credit card Banker’s draft 7. Contact name in the UK if different from that of the applicant 3.EEA(PR) Please complete this page in block capitals and black ink after first reading the payment guidance. if available Date EEA(PR) .£65 6. Amount .single applicant .please give cheque details below (payable to ‘Home Office’) Cheque number Account number Sort code - - 8. Which card are you using for payment? Please tick a box Visa/Electron Mastercard/Amex Maestro/Solo Delta 9. 1.Payment details . It is mandatory to complete this section. Date of Birth D D M M Y Y Y Y 5. Full name as given in your passport or travel document 4.

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you must include this document with your application (unless you have already returned the document to us). Introduction In accordance with the Immigration (Provision of Physical Data) Regulations 2006 (as amended). or last had: • a residence card (biometric format) confirming your right to reside under the EEA Regulations. You will be charged an additional handling fee for this service. This is issued as a separate biometric card and not as a vignette or sticker in your passport. EEA(PR) .uk/ biometric-residence-permits Definitions In this section. you must complete this section in full. If you are a non-EEA national applying for a permanent residence card. or other document. Your application may be rejected as invalid if you do not enrol your biometric information when requested.gov. travel document. You must pay the fee by cash or debit card when you attend your biometric enrolment appointment. please visit www. Do not send the biometric enrolment fee with your application fee.Biometric information for non-EEA nationals: form EEA(PR) Note: this section applies to non-EEA nationals applying for a permanent residence card only.Version 04/15 Page 7 of 127 . permanent residence card or derivative residence card issued under the EEA Regulations after you have given your biometric information. payable to the Post Office Ltd. When we receive your application. If you currently have. we will send you a biometric enrolment letter. we may reject your application and return it to you without consideration. the term ‘residence card (biometric format)’ means a residence card. You must complete this section fully to ensure that we have the correct information when you attend your biometric appointment. any non-EEA national applying for a permanent residence card as evidence of their right to reside under the Immigration (European Economic Area) Regulations 2006 (as amended) (‘the EEA Regulations’) must give their biometric information (fingerprints and a digital photograph) before their application will be considered. If you do not. Do not complete this section if you are an EEA national applying for a document certifying permanent residence – proceed straight to section 1 instead. or • a biometric residence permit confirming that you had been granted leave to remain under the Immigration Rules or Immigration Act 1971. This will instruct you to make an appointment at a designated Post Office to have your biometric information recorded. For more information about biometrics.

answer ‘no’ to the above question. You must include this document with your application.please tick (Please state) Mr Mrs Miss Ms Master Other Your full name: Your nationality: Your date of birth: D D M M Y Y Y Y Village. EEA(PR) . or other document (such as an ‘immigration status document’).Version 04/15 Page 8 of 127 . please give details of your residence card (biometric format) or BRP below. unless it is not available for one of the reasons specified below. If yes. town or city of birth: Country of birth: Your home address in the UK: Postcode Current or previous residence card (biometric format) or biometric residence permit 2. travel document.Your personal details 1. Your title . Have you been issued with a residence card (biometric format) or biometric residence permit (BRP) in connection with a previous application under the EEA Regulations or for leave to remain? Yes go to question 3 No go to question 13 Note: if you were last issued with a residence card under the EEA Regulations in the form a vignette or sticker in your passport.

Residence card (biometric format) or BRP number: 4. If the residence card (biometric format) or BRP was stolen.Version 04/15 Page 9 of 127 .go to question 12 9. Expiry date: D D M M Y Y Y Y 6. Place of issue: 8.go to question 11 Other . If the residence card (biometric format) or BRP has been returned to the Home Office.go to question 10 Lost . Issue date: D D M M Y Y Y Y 5. Residence card (biometric format) or BRP enclosed? Yes No If not enclosed then please state where the residence card (biometric format) or BRP is now: Returned to Home Office . please give details below. Police report number: Crime reference number: EEA(PR) .go to question 9 Stolen . Nationality recorded on the residence card (biometric format) or BRP: 7.3. Reason it was returned: Date it was returned: D D M M Y Y Y Y 10. please give details below.

continue on a separate sheet and enclose it with this application form. The name in which your fingerprints were taken Date on which Place at which they they were taken were taken (DD/MM/YYYY) EEA(PR) . If the residence card (biometric format) or BRP was lost.Police station: Date reported to the police: D D M M Y Y Y Y Date reported to the Home Office card management service: D D M M Y Y Y Y 11. please explain why you are unable to provide it below: Fingerprints in previous immigration applications 13. If the residence card (biometric format) or BRP is not enclosed for any other reason. Have you had your fingerprints taken as part of a previous UK immigration application made in the UK or abroad (including for an EEA family permit)? Yes continue below No go to question 14 Please give details below for each case. Date it was lost: D D M M Y Y Y Y Where it was lost: Date reported to the Home Office card management service: D D M M Y Y Y Y 12.Version 04/15 British diplomatic post if they were taken abroad Page 10 of 127 . please give details below. If you need more space.

If that person is not the parent or guardian of the child. EEA(PR) . No Applicants under the age of 16 15. Is the responsible adult your parent or legal guardian? Yes go to question 19 No go to question 18 Note: The responsible adult accompanying any child under the age of 16 will need to provide a form of photographic identification. Any child under the age of 16 must be accompanied by a responsible adult when they attend their biometric appointment. they must have a letter confirming that they are a responsible adult who has a close connection to the child and has been authorised to accompany him or her.Version 04/15 Page 11 of 127 . such as a passport or UK photo driving licence. Are you under the age of 16? Yes answer questions 16 to 18 No go to question 19 16. Please give details of the person who will be accompanying you when you attend your biometric appointment. Name of responsible adult: Date of birth of responsible adult: D D M M Y Y Y Y Nationality of responsible adult: Relationship of responsible adult to you: 17. Do you have a medical or physical condition which may require special arrangements for your biometric features to be recorded? Yes Please provide us with a letter from a treating clinician registered with the General Medical Council (GMC) giving details of the condition and/or special needs and explaining any arrangements that may be necessary.Special arrangements for medical conditions 14.

EEA(PR) .18. As required by the Immigration (Provision of Physical Data) Regulations 2006 (as amended). I confirm that I am applying for a residence card (biometric format) for myself. Please explain why your parent or legal guardian will not be accompanying you to the appointment: Declaration 19. I understand that the Home Office may make enquiries about any responsible adult nominated to be present when my fingerprints and/or a photograph are taken. If I am a sole applicant under the age of 16.Version 04/15 Page 12 of 127 . Signed Date D D M M Y Y Y Y Now go to section 1.

please tick (Please state) Mr 1.3 Mrs Miss Ms Master Other Your full name as shown in your passport. even if you have already completed the biometric section. A copy of the photograph guidance can be found at: www.Version 04/15 Page 13 of 127 .1 Which document are you applying for? Please tick: I’m an EEA national and I’m applying for a document certifying permanent residence I’m a non-EEA national and I’m applying for a permanent residence card Photographs .2 Your title .Applicant’s details You must complete this section as required. travel document or EEA national identity card 1.gov. Please make sure that the staple or paper clip does not damage or mark the photographs. All photographs must be as specified in the photograph guidance. If you do not. travel document or EEA national identity card 1. why did you change it? Marriage/civil partnership Divorce Other (please state) EEA(PR) .4 Surname or family name as shown in your passport.6 If you have changed your name. Please place the photographs in a small sealed envelope and attach it across this box with a staple or paper clip at the right-hand side.uk/photos-for-passports Your name 1.5 Any other name(s) by which you are or have been known Name(s) Dates during which you have used this/these name(s) 1.Section 1 . Document applied for 1.You must provide two recent identical photographs of yourself with your full name on the back of each one. your application may be delayed or even refused.

8 What is your relationship status? Female Married Dissolved civil partnership Civil partner Surviving civil partner Single Unmarried partner Divorced Separated Widow / widower Separation order Your date of birth.Your gender and relationship status 1. town or city of birth 1. or have you ever held.14 No If Yes. travel document or national identity card) 1. please write ‘present’.9 Your date of birth 1.12 Your current nationality (as stated in your passport.7 What is your gender? Male 1. EEA(PR) . any other nationality or citizenship? Yes 1.10 Village.13 Do you currently hold.11 Country of birth D D M M Y Y Y Y 1.Version 04/15 Page 14 of 127 . place of birth and nationality 1. please give details below: Nationality or citizenship Dates held From (DD/MM/YYYY) To (DD/MM/YYYY)* * If you still hold the relevant nationality or citizenship.

valid national identity card No 1.16 Are you submitting a valid passport. travel document or national identity card: Unless your valid passport.Your passport or national identity card 1.17 If you have answered no to question 1. Passport or travel document National identity card (EEA national only) Document reference number Place of issue Issuing authority Date of issue Expiry date 1. travel document or national identity card is already with the Home Office. Please say what this evidence is in the box below Please note: we will only accept alternative evidence of your identity and nationality if you can show that you are not able to submit a valid passport. you must also submit alternative evidence of your identity and nationality. EEA(PR) . please say why not in the box below and submit any relevant supporting evidence Reason(s) for not submitting a valid passport.16. travel document or national identity card due to circumstances beyond your control.Version 04/15 Page 15 of 127 . valid travel document Yes. travel document or (if you are an EEA national) national identity card in the table below. valid passport Yes. travel document or (if you are an EEA national) national identity card with this application? Yes.15 Please give details of your current passport.

24 Your name and address in the UK for all correspondence if different from your home address: Postcode 1.25.21 Residence card or registration certificate number: 1. please write ‘N/A’ (not applicable) in the relevant box or leave it blank.Version 04/15 Page 16 of 127 .Your personal reference numbers 1.20 Biometric residence permit number: 1.25 Is the address in 1. Regulated by the Office of the Immigration Services Commissioner (OISC) OISC reference number: EEA(PR) .22 Any other Home Office reference number: If you do not have any of the above reference numbers. Your contact details 1.24 the address of your representative or authorised immigration adviser? Yes No Not applicable 1.18 Home Office reference number(s): 1.19 UK national insurance number: 1. ask your representative.23 Your home address in the UK: Postcode 1. how is your representative authorised? If you are not sure.26 If you have answered yes to question 1.

please enter their details in the table on the following page.Version 04/15 Page 17 of 127 . You must check your email account at regular intervals and respond to any further information requests as soon as possible. We strongly recommend that you enclose all applications in the same envelope if you want them to be considered together.Regulated by the Law Society or other relevant professional body or regulator Registered or authorised in an EEA state Supervised Exempt.30 If you have a partner or other family members or relatives applying for European residence documentation at the same time as you. Continue on a separate sheet if necessary.27 Your home/daytime telephone number 1.29 Your email address and that of your representative if you have one.28 Your mobile number if you have one 1. This will help us keep your applications together. or employed or supervised by an exempt person Specified by Order I don’t know 1. Your email address: Please re-enter your email address in block capitals: Your representative’s email address: The Home Office or person’s acting on behalf of the Home Office may use the above email address(es) to communicate with you about your application. Other family members of the EEA national applying at the same time as you 1. Please note that each family member must complete their own application form and pay the specified application fee. Please write your email address clearly in block capitals and note that we can only send updates to the email address you provide. EEA(PR) .

Version 04/15 Page 18 of 127 .Full name Nationality Date of birth (DD/MM/YYYY) Application form used or document applied for Now go to section 2. EEA(PR) .

also complete the relevant section(s) as indicated in question 2. 18. and 19. 17. 16. I’m the family member or extended family member of an EEA national former worker or selfemployed person who has died. 9. Category of application 2. or a combination of these. 18. Complete sections 5. Complete sections 5. are you applying to replace that document because it has been permanently lost or stolen or renew it because it has expired? Note: if your document has been revoked or cancelled by the Home Office. Complete sections 5. Complete sections 5. 9. then complete sections 17. EEA(PR) . 16. 18. permanent residence card. 7. 17. tick no.1 Have you previously been issued with a document certifying permanent residence. 9.2 No go to 2.3 Please tick the relevant box(es) below to indicate how you have acquired permanent residence I’ve lived in the UK for a continuous period of five years as an EEA national qualified person. the family member or extended family member of a qualified person. or residence permit or residence document endorsed to say you can stay in the UK indefinitely? Yes go to 2. I’m the family member or extended family member of an EEA national who ceased activity.3 2.2 If you answered yes to 2.3 below 2. 6. and 19 (and the relevant section(s) as indicated in question 2.) I’m an EEA national who ceased activity (stopped work or self-employment) due to retirement. Yes go to straight to section 3.About your application Complete this section to indicate the basis on which you’re applying for a document certifying permanent residence or permanent residence card and then complete the relevant sections as directed. 9.4 below). and 19 (and the relevant section(s) as indicated in question 2.Version 04/15 Page 19 of 127 . 17. 7. 16. 16. (If you are or have been a family member or extended family member. permanent incapacity or because I’m now active as a worker or self-employed person in another EEA state. 18 and 19.Section 2 .1.4 below). 18 and 19 No go to 2. 17.4 below.

in addition to the sections mentioned above. I’m an extended family member (relative) of the EEA national sponsor.4 below). residence card or EEA family permit) throughout the relevant qualifying period. Complete section 14. or have been. Complete section 11.4 If you’re applying on the basis that you are. I am or have been the dependent child or grandchild aged 21 or over. 17. Complete section 15. parent. or their marriage or civil partnership ended in divorce. Family members and extended family members 2. or of their spouse or civil partner. 8. I’m an extended family member (relative) of the EEA national sponsor. and I’ve lived in the UK for a continuous period of five years (including time spent as a family member). an extended family member of the relevant EEA national. 10. or have been. or you have retained your right of residence. 17. Complete sections 5. I am or have been the descendant (child or grandchild) aged under 21 of the sponsor. and I strictly require their personal care on serious health grounds. 18 and 19 (and the relevant sections as indicated in question 2. 9. or grandparent of the sponsor (or of the sponsor’s spouse or civil partner). Complete section 12. Note: if you are. or unmarried or same-sex partner of the sponsor.I’ve retained my right of residence after my EEA national family member died or left the UK.4 below). and I’m dependent on them and/or I’m a member of their household. 18 and 19 (and the relevant section(s) as indicated in question 2. EEA(PR) . Complete section 13. I’m the family member of a British citizen who exercised their free movement rights in another EEA state before returning to the UK and I’ve lived in the UK for a continuous period of five years as their family member (‘Surinder Singh’ route). You must also complete section 4 with details of your sponsor.Version 04/15 Page 20 of 127 . please indicate the category of family member below and complete the relevant section. Complete sections 5. or of the sponsor’s spouse or civil partner. annulment or dissolution. civil partner. 16. I am or have been the spouse. the family member or extended family member of a relevant EEA national or British citizen (your ‘sponsor’). or of their spouse or civil partner. you must have held valid residence documentation (registration certificate.

leave it blank. If a section does not apply to you. To save paper. In all cases. please also complete the Identity Document Checklist on the final page of this form. we recommend that you only print and send us the front page(s) of the form and the sections of the form that you have actually completed. postage and storage costs.Version 04/15 Page 21 of 127 . EEA(PR) .Only complete the sections of the form that are relevant to you.

If the relevant document was revoked or cancelled. or • a residence document issued to a non-EEA national under the EEA Regulations 2000 endorsed to say you can stay in the UK indefinitely. About your permanent residence document 3.8 EEA(PR) . you cannot apply to replace or renew it and will need to qualify for permanent residence again. ‘permanent residence document’ means— • a document certifying permanent residence issued to an EEA national under the EEA Regulations 2006. • a permanent residence card issued to a non-EEA national under the EEA Regulations 2006. • a residence permit issued to an EEA national under the EEA Regulations 2000 endorsed to say you can stay in the UK indefinitely.1 Which document do you wish to replace or renew? Document certifying permanent residence Residence permit endorsed to say you can stay in the UK indefinitely Permanent residence card Residence document endorsed to say you can stay in the UK indefinitely 3. or you have been outside the UK for a continuous period of more than two years since it was issued. or it has expired and you would like to renew it. In this section.7 and 3.Section 3 .Version 04/15 Page 22 of 127 .5 then 3.2 Give details of the document below Date of issue: D D M M Y Y Y Y D D M M Y Y Y Y Document reference number: Date of expiry (if stated): 3. Note: only complete this section if you still have a permanent right of residence.Replace or renew your permanent residence document Complete this section if you have previously been issued with a permanent residence document (see below for definition) under the Immigration (European Economic Area) Regulations 2006 or 2000 (‘EEA Regulations’) but that document has been permanently lost or stolen and you would like to replace it.4 and 3.3 Why do you wish to replace or renew it? Document is permanently lost – answer questions 3.

6 below and provide relevant evidence – e.7 and 3.Version 04/15 Page 23 of 127 .5 then 3. we cannot replace your document. If this is the case. The only exception to this is if the document was retained by your national authorities (for example.8 Document has expired (permanent residence card only) – answer questions 3.g.6 If you have ticked ‘Other reason’ in question 3. 3.Document has been stolen – answer questions 3.5 Give details of when and where you reported the loss or theft of the document Where was it lost/stolen? When was it lost/stolen? D D M M Y Y Y Y Name of the police station to which you reported the loss or theft: Date you reported it: D D M M Y Y Y Y Crime reference number: You must include evidence with your application – see section 18 Other reasons 3.6. when you renewed your passport).4 and 3. 3. did you report this to the police? Yes No If you have answered no.4 If the document has been permanently lost or stolen. give further information in 3.3. EEA(PR) . give the full reason(s) below and provide any relevant supporting evidence.8 Document permanently lost or stolen 3.7 and 3. a letter from your country’s embassy.7 and 3.8 Other reason – answer questions 3.

Absences from the UK 3.8 Give details of your absences from the UK since the document was issued. Now go to section 17. Continue on a separate sheet if necessary and enclose with your application. Do not include the day you left the UK or returned to the UK. have you at any time been absent from the UK for a continuous period of more than two years? Yes No If you have answered yes. 3. EEA(PR) .Version 04/15 Page 24 of 127 . You must also provide evidence of your continued residence in the UK since it was lost. enter 29 days (2 January to 30 January inclusive).7 Since you were issued with your permanent residence document. you will have lost your right to permanent residence and should not complete this form. For example. Country or countries visited Date of departure Date of return Number of days* * Enter whole days’ absences only. if you were absent from the UK between 1 January 2014 and 31 January 2014.

unless you’re applying as the family member of an EEA national who ceased activity. left the UK. Please place the photograph(s) in a small sealed envelope and attach it across this box with a staple or paper clip at the right-hand side.gov. Your sponsor’s personal details Photographs . or has been. This is normally five years. or • British citizen family member who has exercised free movement rights in an EEA state other than the UK (if you’re applying under the ‘Surinder Singh’ route). a qualified person or who has permanent residence. A copy of the photograph guidance can be found at: www.uk/photos-for-passports If you cannot provide a photograph of your sponsor because they have died. during the relevant qualifying period.3 Surname or family name as shown in their passport or national identity card EEA(PR) . or if you’re applying on the basis that you have retained your right of residence. you have mainly had a right of residence as a family member or extended family member.Version 04/15 Page 25 of 127 . or who has died. • EEA national former family member who was a qualified person or had permanent residence (if you’re applying in the retained right of residence category). Please make sure that the staple or paper clip does not damage or mark the photograph(s). ‘Relevant qualifying period’ means the period required to acquire permanent residence.please tick (Please state) Mr Mrs Miss Ms Master Other 4. or you’re unable to contact them. All photographs must be as specified in the photograph guidance. A. ‘Sponsor’ means the person from whom you derive your right of residence in the UK and who is your: • EEA national family member or extended family member who is. tick the box below: Your sponsor’s name 4.Your sponsor Complete this section with details of your sponsor if.1 Title .Section 4 .2 Full name as shown in their passport or national identity card 4.Enclose at least one passport-sized photograph of your sponsor with their full name written clearly on the back.

place of birth and nationality 4.Version 04/15 Page 26 of 127 .9 Village. known by Name(s) 4. town or city of birth D D M M Y Y Y Y 4.6 What is their gender? Male 4.5 Dates during which they have used this/these name(s) If they have changed their name.11 Their current nationality (as stated in their passport or national identity card) EEA(PR) . why did they change it? Marriage/civil partnership Divorce Other (please state) Your sponsor’s gender and relationship status 4.4 Any other name(s) they are or have been.7 What is their relationship status? Female Married Dissolved civil partnership Civil partner Surviving civil partner Single Unmarried partner Divorced Separated Widow / widower Separation order Your sponsor’s date of birth.4.10 Country of birth 4.8 Date of birth 4.

14 Please give details of your sponsor’s current passport or national identity card in the table below. please say why not below. Passport National identity card Document reference number Place of issue Issuing authority Date of issue Expiry date 4.15 Are you submitting your sponsor’s valid passport or national identity card with this application? Yes.Version 04/15 Page 27 of 127 . valid national identity card No 4. Evidence of your sponsor’s identity and nationality 4.12 Do they currently hold. EEA(PR) . any other nationality or citizenship? Yes 4. valid passport Yes. please give details below: Nationality or citizenship Dates held From (DD/MM/YYYY) To (DD/MM/YYYY)* * If you still hold the relevant nationality or citizenship.15.16 If you have answered no to question 4. or have they ever held. please write ‘present’.13 No If Yes.4.

if different from your address given in section 1.Version 04/15 Page 28 of 127 . Postcode EEA(PR) .22 Please give your sponsor’s home address in the UK.19 Registration certificate number: 4. Your sponsor’s contact details 4.You must also submit alternative evidence of your sponsor’s identity and nationality.21 Any other Home Office reference number: If your sponsor does not have any of the above reference numbers. Your sponsor’s personal reference numbers 4. please write ‘N/A’ (not applicable) in the relevant box or leave it blank.17 Home Office reference number(s): 4.18 UK national insurance number: 4. Please say what this is below.20 Document certifying permanent residence number: 4.

and you’re their (or their spouse’s/civil partner’s) grandchild. or of the sponsor’s spouse or civil partner Grandchild (see Note 2) aged under 21 of the sponsor. parent. (2) Extended family member of the relevant EEA national (see Note 3) Note 3: If you’re applying as an extended family member. residence card or EEA family permit) throughout the relevant qualifying period. or of the sponsor’s spouse or civil partner Dependent parent (see Note 2) of the sponsor.g.23 Please tick the relevant box(es) below to show how you are. or been their dependent relative or a relative who strictly requires their personal care). a right to reside as a student. or of the sponsor’s spouse or civil partner Dependent grandchild aged 21 or over (see Note 2) of the sponsor. Spouse Civil partner Child aged under 21 of the sponsor. Complete (1) if you are (or were) their family member or (2) if you’re their extended family member. or of the sponsor’s spouse or civil partner Note 2: If your sponsor is an EEA national who only has. you must have been in a durable relationship with the relevant EEA national. EEA(PR) . (1) Family member of the relevant EEA national or British citizen (see Note 1) Note 1: If you’re claiming to have retained your right of residence as the former family member of a relevant EEA national. Your relationship to your sponsor 4. or grandparent. you must have: • held valid residence documentation (registration certificate. related to your sponsor (the person named in subsection A above). or of the sponsor’s spouse or civil partner Dependent child aged 21 or over of the sponsor. or has had. please tick the relevant box(es) to show how you were related to that person before your family relationship ended. you must qualify as their extended family member instead and should tick the relevant box in (2) below. and • met the definition of ‘extended family member’ throughout the relevant qualifying period (e. or were.Version 04/15 Page 29 of 127 . or of the sponsor’s spouse/civil partner Dependent grandparent (see Note 2) of the sponsor.B.

or of their spouse/civil partner Nephew/niece of the relevant EEA national. please explain in more detail how you’re related to them.Unmarried partner or same-sex partner of the EEA national. parent or grandparent. EEA(PR) . and you’re their grandchild. See section 18 for guidance on the evidence you must submit. you should tick the relevant option under ‘family member’ instead. or of their spouse/civil partner Aunt/uncle (including great aunt/uncle) of the relevant EEA national. in a durable (lasting) relationship with them Brother/sister of the relevant EEA national. or of their spouse/civil partner Cousin of the relevant EEA national. Now go to section 5. in the case of a partner. or of the sponsor’s spouse or civil partner.24 If you’re not the brother. You must also complete the relevant section(s) with information about your relationship – see section 2 for guidance on which section(s) you must complete. or of their spouse/civil partner Grandparent (see Note 4) of the relevant EEA national. or of their spouse/civil partner Other . if you’re a ‘first cousin once removed’ of an EEA national on your mother’s side. You must provide evidence of how you’re related to your sponsor or. 4. or of their spouse/civil partner Parent (see Note 4) of the relevant EEA national. mother or father of the sponsor. If your sponsor is/was a worker. sister.please state: Note 4: Only tick parent. or a jobseeker.Version 04/15 Page 30 of 127 . For example. or has permanent residence. self-employed. you could state ‘my mother is the first cousin of the relevant EEA national’. in a durable (lasting) relationship with them. or of their spouse/civil partner Grandchild (see Note 4) of the relevant EEA national. selfsufficient. grandparent or grandchild in the table above if your sponsor only has a right to reside in the UK as a student.

EEA(PR) .Residence in the UK and previous EEA documentation Complete this section with details of your and (if applicable) your sponsor’s residence in the UK and any EEA residence documentation that you currently hold. if applicable) had any absences from the UK since you/they entered? Yes No If yes. date your sponsor entered the UK D D M M Y Y Y Y Born in UK Or not applicable 5. A.2 If you are applying as a family member or extended family member. You: Country or countries visited Date of departure Date of return Number of days* Date of departure Date of return Number of days* Your sponsor (if applicable) Country or countries visited * Enter whole days’ absences only. or because you have retained your right of residence. For example. Residence in the UK 5.1 Date you first entered the UK D D M M Y Y Y Y or Born in the UK 5. Do not include the day you left the UK or returned to the UK. enter 29 days (2 January to 30 January inclusive).Version 04/15 Page 31 of 127 . please give details in the tables below. or have previously held. Continue on a separate sheet if necessary and enclose with your application. if you were absent from the UK between 1 January 2014 and 31 January 2014.Section 5 .3 Have you (or has your sponsor.

5. or have you previously been issued with. EEA(PR) . study or vocational training.4 If you were or your sponsor was absent from the UK for more than six months in any 12-month period. Current or previous EEA residence documentation 5.5 Do you currently hold. or an overseas employment posting Give further details below. Continue on a separate sheet if necessary and enclose with your application B. such as pregnancy and childbirth. pleaes provide details below Document Date of issue EEA family permit Date of expiry Document reference number Registration certificate Residence card Document certifying permanent residence Permanent residence card Derivative residence card* * Note: time spent in the UK with a derivative right of residence does not count towards permanent residence. please indicate the reason for the absence by ticking the relevant box below: Military service Other important reasons. any EEA residence documentation listed in table below? Yes No If yes.Version 04/15 Page 32 of 127 . serious illness.

such as a police lost property report).5. details of when you reported it to the police. or were.7 Have any of the above documents since been revoked or cancelled by the Home Office? Note: only answer ‘yes’ if you have received a formal notice from the Home Office telling you that it has been revoked. if the document was stolen. and evidence that you reported it. provide details below: 5. the family member or extended family member of the sponsor named in section 4? Yes No If yes. Do not answer ‘yes’ if the document has simply expired. crime reference number. please explain why you are not enclosing it/them and provide any relevant supporting evidence (e.g.9 If you have answered no to 5. EEA(PR) . Yes No If yes.6 Were any of the above documents issued to you on the basis that you are.8 Are you enclosing the relevant document(s) with your application? Yes No 5. provide details below: 5. Now go to— • Section 6 if you’re the family member or extended family member of an EEA national who has died • Section 7 if you are. or if it was cancelled by a Border Force (immigration) officer. an EEA national who has ceased activity • Section 8 if you have retained your right of residence • Section 10 if you’re the family member of a British citizen and applying under the ‘Surinder Singh’ judgment • Section 9 in all other cases.Version 04/15 Page 33 of 127 . or your sponsor is.8.

Note: if you’re applying as an extended family member. Give details of that document in section 5 and enclose it with your application. give details below: Now go to section 9.5 No Was your sponsor’s death due to an accident at work or an occupational disease? Yes No If yes.4 Had your sponsor lived in the UK for at least 2 years immediately before they died? Yes 6. or EEA family permit) as the relevant EEA national’s extended family member immediately before their death. residence card.3 D D M M Y Y Y Y No What was your sponsor’s status immediately before they died? Worker Self-employed You must give further details of your sponsor’s activity in section 9.2 Were you living with your sponsor immediately before they died? Yes 6. EEA(PR) .Section 6 . you must have held valid residence documentation (registration certificate. 6. 6.Family member or extended family member of an EEA national worker or self-employed person who has died Complete this section if your sponsor was an EEA national worker or self-employed person who has died and you were living with them as their family member or extended family member immediately before their death.Version 04/15 Page 34 of 127 .1 Date your sponsor died 6.

7. • are permanently incapacitated. 7. ‘relevant EEA national’ refers to the person (you or your sponsor. as their extended family member. or your sponsor is. Note: if you’re applying as an extended family member of a relevant EEA national who has ceased activity. or • are now active as a worker or self-employed person in another EEA state but you/they still have your/their main home in the UK. or EEA family permit). whichever is applicable) who ceased activity. In the rest of this section. an EEA national who was working or selfemployed in the UK and you or they have ‘ceased activity’ because you/they: • have retired.EEA national former worker or selfemployed person who has ceased activity Complete this section if you are.1 What was the relevant EEA national’s status in the UK immediately before they ceased activity? Worker Self-employed Other (please state) 7.Version 04/15 Page 35 of 127 . were you living in the UK immediately before the relevant EEA national ceased activity? Yes No EEA(PR) .4 How long had the relevant EEA national been working or self-employed in the UK before they ceased activity? Note: you must give details of your/your sponsor’s activity in the UK before you/they ceased activity in section 9.2 Date the relevant EEA national ceased activity D D M M Y Y Y Y 7.3 How long had the relevant EEA national been living in the UK before they ceased activity? 7. valid residence documentation (registration certificate.Section 7 . residence card. you must hold.5 If you are the family member or extended family member of the relevant EEA national. or have held.

give details below: Working or self-employed in another EEA state 7.9 What is the name of the EEA state in which the relevant EEA national is now active as a worker or self-employed person? 7.8 below Now active in another EEA state – answer questions 7.6 Reason the relevant EEA national ceased activity – please tick: Retired when they reached state pension age – go to section 9 Took early retirement (worker only) – go to section 9 Permanent incapacity to work – answer questions 7.9 to 7.10 What is the relevant EEA national doing in the EEA state named above? Worker Self-employed EEA(PR) .7 Was the incapacity the result of an industrial accident or occupational disease? Yes No If yes. give details below: 7.Version 04/15 Page 36 of 127 .16 below Permanent incapacity 7.8 If you answered yes to 7. does the relevant EEA national receive a pension paid in part or in full by an institution in the UK? Yes No Not applicable If yes.7 and 7.7.7.

23 or 4. 7. what is that address? Postcode EEA(PR) . use the box below: 7.Version 04/15 Page 37 of 127 .11 When did the relevant EEA national start work/self-employment in the EEA state? 7.12 Give details of the relevant EEA national’s employment or self-employment in the EEA state below: Name and address of employer or business Job title or position Number of held or type of hours normally business worked each week Salary or wage* Start date of employment or self-employment *Give the figure before deductions for tax.13 If you have any other information to give about the relevant EEA national’s activity in the EEA state. national insurance and other regular deductions.7.22.14 Does the relevant EEA national continue to own or rent property for his or her own use in the UK? Yes No If yes. and the address is different to the one given in section 1.

if you/they were absent from the EEA state between 1 January 2014 and 31 January 2014.16 Complete the table below with details of all absences from the EEA state mentioned above by the relevant EEA national: Country or countries visited Date of departure Date of return Number of days* * Enter whole days’ absences only.Version 04/15 Page 38 of 127 . Now go to section 9.15 How often does the relevant EEA national return to their address in the UK? 7.7. EEA(PR) . enter 29 days (2 January to 30 January inclusive). For example. Do not include the day you/they left or returned to the EEA state.

1 Tick the relevant box below to indicate the basis on which you claim to have retained your right of residence.) In all cases.) I am the parent with actual custody of a child mentioned in subsection B.4 If the sponsor has died.Section 8 . Category of retained right 8.) My sponsor has died or left the UK and I am. you have retained your right of residence for one of the reasons given below. A. and you have now completed 5 years’ continuous residence in the UK (this can include time spent in the UK as the family member of the relevant EEA national). (Complete subsections A. C and E.2 Death of sponsor – one year’s residence Date the sponsor died: D D M M Y Y Y Y 8. E and F.) I. you must submit the relevant evidence listed in section 18. date of their death: D D M M Y Y Y Y 8. B.Version 04/15 Page 39 of 127 . (Complete subsections D.Retained right of residence Complete this section if you previously had a right of residence as the family member of a relevant EEA national (your ‘sponsor’ named in section 4).5 If the sponsor has left the UK. annulment or dissolution. My sponsor has died and I had lived in the UK for at least one year at the time of his or her death. date they left the UK: D D M M Y Y Y Y EEA(PR) . E and F. Sponsor died or left the UK – child or children in education 8. or a family member is. was the spouse or civil partner of the sponsor and the marriage or civil partnership has legally ended in divorce. or one of my family members. (Complete subsections B.3 How long had you been living in the UK as the family member of the sponsor at the date of the sponsor’s death? Years Months Now go to subsection E. 8. a child of the sponsor (or of their spouse/civil partner) who is in education. (Complete subsections B and E.

or continue on a separate sheet. and enclose with your application When you have completed this subsection.Version 04/15 Dates attended (from and to) Page 40 of 127 . Name and address of school(s) or college(s) attended EEA(PR) .10 No No Give further details of the child’s education in the UK in the table below.9 Is the child currently in education in the UK? Yes 8.7 How is (or was) the child related to the sponsor at the time of his/her death or departure from the UK? Child/grandchild of the sponsor Child/grandchild of the person who was spouse or civil partner of the sponsor when he or she died or left the UK 8. If there are more than two children. go to subsection E below.6 Full name of the child: 8. Child 1 8.Please give details of all children who qualify in this subcategory. make a copy of this page.8 Was the child in education at the time the sponsor died or left the UK? Yes 8.

Name and address of school(s) or college(s) attended EEA(PR) .14 Is the child currently in education in the UK? Yes 8.Child 2 8.13 Was the child in education at the time the sponsor died or left the UK? Yes 8.Version 04/15 Dates attended (from and to) Page 41 of 127 .11 Full name of the child: 8.12 How is (or was) the child related to the sponsor at the time of his/her death or departure from the UK? Child/grandchild of the sponsor Child/grandchild of the person who was spouse or civil partner of the sponsor when he or she died or left the UK 8.15 No No Give further details of the child’s education in the UK in the table below.

C. Continue on a separate sheet if necessary and enclose with your application. Full name of child Date of birth Nationality Relationship to sponsor 8. Parent with actual custody of a child or children in education mentioned in subsection B 8.16 Please confirm the name(s) of the child or children of whom you have custody.19 Please confirm who is the former spouse or civil partner of the EEA national sponsor: I am the former spouse or civil partner of the sponsor A member of my family is the former spouse or civil partner of the sponsor If you have ticked ‘a member of my family’.please state Now go to subsection E.Version 04/15 Page 42 of 127 . D. make sure you complete section 11 with details of the relationship. Marriage or civil partnership ended by divorce.18 What kind of custody is this? Please tick: Court order Relationship to you By agreement with the sponsor Other . annulment or dissolution Note: if you’re the former spouse or civil partner of the sponsor. give their details below: EEA(PR) . (1) General questions 8.17 How long have you had custody of the relevant child/children? 8.

24 M M No Was your sponsor present in the UK at the date of divorce.21 Date legal proceedings began to end the marriage or civil partnership (that is.25 If no. if you are not the former spouse/civil partner) been living in the UK at the date of divorce.27 How long had you (or the family member named in question 8. where were they and why? (For example. annulment or dissolution? 8. annulment or dissolution? Yes No 8. was issued): D D 8. annulment or dissolution? Yes 8. had they left the UK permanently or were they away on business or holiday?) 8.26 How long had your sponsor been living in the UK at the date of divorce.Full name Date of birth D D M M Y Y Y Y Nationality Relationship to you 8. the date the decree absolute. the date the divorce petition. final dissolution order.28 Is the sponsor still living in the UK? EEA(PR) . nullity petition.20 Date of the relevant marriage or civil partnership: D D M M Y Y Y Y 8. was filed): D D M M Y Y Y Y 8.Version 04/15 Page 43 of 127 . or overseas equivalent. or overseas equivalent. annulment or dissolution? 8.19. dissolution petition.23 Y Y Y Y Were you living in the UK at the date of divorce.22 Date the marriage or civil partnership was legally ended (that is.

19 has access rights in the UK to a child of the sponsor and the child is aged under 18. you may wish to complete the remaining questions in this subsection if you feel they are relevant to your circumstances. or a member of my family. and the relevant EEA national sponsor) lived in the UK for at least one year while they were still married or in a civil partnership .29 Don’t know D D M M Y Y Y Y Please tick which of the following applies to you (tick more than one box if relevant): The marriage or civil partnership referred to above lasted for at least three years before legal proceedings began to end it.19 does If ’someone else’. The parties to the marriage or civil partnership (that is. Answer the questions under (2) below. or the family member referred to in question 8. or there are other particularly difficult circumstances which justify retaining the right of residence. (2) Custody of a child of the sponsor 8.19 has custody of a child of the sponsor.Version 04/15 Someone else does Relationship to child Page 44 of 127 . Answer the questions under (3) below. when did they leave the UK? 8.31 I do Date of birth Nationality Who has custody of the child(ren)? The person named in 8. you.Yes No If no. was the victim of domestic violence while the marriage or civil partnership referred to above was subsisting. If you have ticked the two boxes immediately above. However. you can go straight to subsection E below. I have/the person named in 8. Complete subsection (4) below. give their details below: Full name Date of birth Nationality EEA(PR) .30 Details of the relevant child(ren): Full name of the child 8.19. I have/the person named in 8. I.

Version 04/15 Page 45 of 127 .36 Someone else does Nationality Relationship to child Has a court ordered that access must take place in the UK? Yes 8.33 How long have you/they had custody of the child/children? (3) Access rights to a child aged under 18 of the sponsor 8.37 Nationality No How long have you/your family member had these access rights? Note: you must include the relevant court order with your application.35 Date of birth Who has access rights to the child? I do The person named in 8.8. EEA(PR) .34 Details of the relevant child(ren): Full name of the child 8.19 does If ’someone else’.please state 8. give their details below: Full name Date of birth 8.32 What kind of custody is this? Court order By agreement with the sponsor Other .

Now go to subsection F below. the victim of domestic violence while the marriage or civil partnership was subsisting. student. jobseeker). Your sponsor’s status in the UK at the relevant date 8. please give details below.38 If you were. self-employed (including retained self-employed status). EEA(PR) . or when your (or your family member’s) marriage/civil partnership legally ended (‘the relevant date’). or a family member was. left the UK. You must also provide relevant evidence – see section 18. Continue on a separate sheet if necessary.(4) Domestic violence or particularly difficult circumstances 8.39 Please indicate below your sponsor’s status on the date they died.Version 04/15 Page 46 of 127 . self-sufficient. Permanent right of residence Qualified person (i. Now go to subsection E (below). E.e. worker (including retained worker status). or there are any other particularly compelling circumstances which you feel justify your retaining your right of residence. You must give details of your sponsor’s activity in the UK while you were still their family member – see section 9.

8. or have been.F.40 Complete the table below with information about your activity in the UK since your sponsor died. left the UK. one year’s residence) or D (marriage/civil partnership ended in divorce.41 If you have indicated that you are. or their marriage/civil partnership ended. please give their details below: Full name Date of birth D D M M Y Y Y Y Nationality Relationship to you EEA(PR) .temporary incapacity Retained worker status .involuntarily unemployed and looking for work Retained worker status .temporary incapacity Self-sufficient Family member of a non-EEA national in one of the above categories 8. a family member of a non-EEA national who is/has been working. You must provide this information if you’re applying under category A (death of sponsor. annulment or dissolution).Version 04/15 Page 47 of 127 . Your status in the UK You do not need to complete this subsection if you’re applying under category B (child in education. Activity From (date) To (date) Working for an employer Retained worker status .unemployed and doing vocational training Self-employed Retained self-employed status . self-employed or self-sufficient. sponsor has died or left the UK) or C (parent with custody of such a child).

give details below: Name and address of business Type of business Date started trading Date stopped trading (if applicable) Self-sufficiency If you are or have been (or your non-EEA family member is or has been) self-sufficient.42 If you have (or your non-EEA family member has) been working.Employment 8. Financial resources EEA(PR) . answer the questions below. give details below: Name and address of employer Start date of employment End date of employment (if applicable) Self-employment 8.43 If you have (or your non-EEA family member has) been self-employed.Version 04/15 Page 48 of 127 .

8.45 Give details of what form of comprehensive sickness insurance you have (or your nonEEA family member has) held. income from a pension.46 If you are or have been (or your non-EEA family member is or has been) temporarily unable to work or pursue self-employed activity due to an illness or accident. give details below: Nature of the illness or accident EEA(PR) . E109 or E121) Form S2 (formerly E112) Form S3 Private health insurance plan Temporary incapacity 8. If you need to give any more information. use the box at the end of this section. Source of income How much it is How often you/they receive it Comprehensive sickness insurance 8. and so on.Version 04/15 Page 49 of 127 . investments. income from a family member’s lawful employment or self-employment. This could include savings. Type of insurance Period(s) held (from and to) European Health Insurance Card (EHIC) issued by an EEA member state other than the UK (formerly form E111) Form S1 (formerly E106.44 Please indicate your/your family member’s financial resources.

give details below: Name and address of training provider Title of course and qualification (if relevant) Start date End date 8. how? Looking for work If you have (or your non-EEA family member has) been looking for work after becoming involuntarily unemployed.49 Reason previous employment ended: 8.Version 04/15 Page 50 of 127 .47 If you have (or your non-EEA family member has) been doing vocational training after becoming unemployed. answer the questions below 8. or the Jobs and Benefits Office or Social Security Office in Northern Ireland)? Yes No EEA(PR) .50 Did you/your non-EEA family member register with the relevant employment office (Jobcentre Plus in England.48 If you/your family member left your/their previous employment voluntarily. Wales or Scotland. is/was the training related to your/their previous work? Yes No Not applicable If yes.How long the incapacity to work lasted or is expected to last: Vocational training 8.

If you have no further information to add. further details of financial resources if you’ve indicated that you are/your non-EEA family member is self-sufficient. or periods not accounted for above). leave this blank. EEA(PR) .51 Use the box below if you wish to give any further information about your circumstances (for example. Now go to section 9 to give details of your (former) sponsor’s activity in the UK.Version 04/15 Page 51 of 127 .If yes. date(s) you/your non-EEA family member registered: Other information 8.

1 If you’re applying as the family member or extended family member of the relevant EEA national named in section 4. 9.Section 9 . involuntarily unemployed and looking for work.go to subsection A then subsection B (if relevant) Not applicable .3. EEA(PR) . self-employed person. you should complete this section with details of what your EEA national sponsor (named in section 4 of this form) has been doing. or jobseeker. It also includes periods when you/they were temporarily unable to work due to illness or accident. If you are not the relevant EEA national.3 Yes Are you enclosing the document with your application? No If you have answered yes to question 9. ‘Qualified person’ means an EEA national who is in the UK as a worker.Relevant EEA national’s activity in the UK Complete this section with details of the relevant EEA national’s activity in the UK as a qualified person (also known as ‘exercising Treaty rights’). ‘Relevant EEA national’ means the EEA national who is or has been a qualified person. give details of the document below Date of issue: D D M M Y Y Y Y Document reference number: 9.go to subsection A then subsection B (if relevant) 9. does the relevant EEA national have a document certifying permanent residence? Yes . However.2 No . we reserve the right to ask you for more information if necessary. student. or because you have retained your right of residence.2 If you have answered yes to question 9. or unemployed and doing vocational training. complete subsection A with details of your/the relevant EEA national’s activity in the UK. If you have answered no.go to 9. you do not have to complete the rest of this section – go straight to section 16 instead.Version 04/15 Page 52 of 127 . If the relevant EEA national is or was an accession state national who worked for an employer during the accession period (see subsection B for definitions). you should also complete subsection B. self-sufficient person.1.

Complete in chronological order.13.please state Jobseeker Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other .please state Jobseeker Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other . For each period.4 Complete the table below with details of the relevant EEA national’s (your or your sponsor’s) activity in the UK.please state Jobseeker EEA(PR) .5 to 9.Version 04/15 Page 53 of 127 .12. For any period in which you were/your sponsor was not a qualified person.A. Details of the relevant EEA national’s activity 9. give details at 9. or if you wish to give any further information. Give further details of your/your sponsor’s activity in questions 9. starting from when you/they entered the UK. (1) Summary of the relevant EEA national’s activity From (date) To (date) What you were/your sponsor was (delete as appropriate) doing (please tick relevant box) Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other . indicate what you were/your sponsor was doing by ticking the relevant box. Continue on a separate sheet if necessary.

please state Jobseeker Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other .Table continued From (date) To (date) What you were/your sponsor was (delete as appropriate) doing (please tick relevant box) Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other .please state Jobseeker Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other .Version 04/15 Page 54 of 127 .please state Jobseeker EEA(PR) .please state Jobseeker Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other .

etc. national insurance.5 For any period in which you were (or your sponsor was) working for an employer. make a copy of this table or continue on a separate sheet and enclose with your application. please give details in the table below.please state Jobseeker (2) Employment 9. If you need more space.Table continued Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other . EEA(PR) . Name and address of employer Start date of End date of Salary/ employment employment wage* Reason for leaving (if applicable) * Give the ‘gross’ figure before deductions for tax. month or year.Version 04/15 Page 55 of 127 . Say whether per week.please state Jobseeker Working Temporary incapacity Self-employed Vocational training Self-sufficient Family member only Studying Other .

Continue on a separate sheet if necessary and enclose with your application. please give details below: Nature of the illness or accident: Period(s) during which you/they were unable to work: (5) Study or vocational training 9.Version 04/15 Page 56 of 127 . you must also complete subsection B. please give details in the table below. you were/your sponsor was temporarily unable to work or pursue self-employed activity due to an illness or accident. (3) Self-employment 9.7 If. during the relevant qualifying period. Continue on a separate sheet if necessary and enclose with your application. or your sponsor was. please give details below.Note: if you are/your sponsor is a (former) accession state worker. EEA(PR) . a student or doing vocational training.6 For any period in which you were. self-employed.8 For any period in which you were. Name and address of business (4) Type of business Date started trading Date stopped trading (if applicable) Temporary incapacity 9. or your sponsor was.

how much you/they received and (where relevant) how often you/they received it (e. income from lawful employment or self-employment. EEA(PR) . college. Continue on a separate sheet if necessary. money from a friend or relative.9 For any period in which you were. or your sponsor was. year).Name and address of school. etc). income from rental property. or training provider (6) Title of course and qualification Start date End date Study or self-sufficiency – financial resources 9.10 If you have any other relevant information about your/your sponsor’s financial resources. own savings. every week. a student or self-sufficient person.g. use the box below. month. university. Source of income How much you/ they receive(d) How often you/they receive(d) it 9. please state what financial resources were available to you/them. Indicate the source of the income (for example. scholarship or bursary.Version 04/15 Page 57 of 127 .

Continue on a separate sheet if necessary. Yes No If yes.11 For any period in which you were. the Jobs and Benefits Office or Social Security Office in Northern Ireland)? Tick yes even if claiming national insurance credits only. (In the case of a self-sufficient person.12 If you were/your sponsor was in the UK looking for work during the relevant qualifying period. If you do not have any further information to add. indicate below how you/they met the requirement to hold comprehensive sickness insurance cover. dates you/they were registered: (9) Other periods not accounted for above 9. the insurance must also cover family members in the UK. were you/was your sponsor registered as a jobseeker with the relevant employment office (Jobcentre Plus in England. EEA(PR) .13 If there are any periods not accounted for in the questions above. a student or self-sufficient person. leave this blank.Version 04/15 Page 58 of 127 .) Type of insurance Period(s) held (from and to) European Health Insurance Card (EHIC) issued by an EEA member state other than the UK (formerly form E111) Form S1 (formerly E106. or your sponsor was. or if there is any further information you would like to give to explain how you acquired permanent residence in the UK. Scotland and Wales. please provide this information in the box below. E109 or E121) Form S2 (formerly E112) Form S3 Private health insurance plan (8) Looking for work (jobseeker or retained status worker) 9.(7) Study or self-sufficiency – comprehensive sickness insurance 9.

you/they must have worked for an uninterrupted period of 12 months in accordance with a relevant registration or authorisation document to become exempt. EU8 nationals Accession period: Relevant scheme: Czech Republic Lithuania 1 May 2004 to 30 April 2011 worker registration scheme (WRS) Estonia Poland Hungary Slovakia Latvia Slovenia EU2 nationals Accession period: Relevant scheme: Bulgaria 1 January 2007 to 31 December 2013 worker authorisation arrangments Romania EU1 nationals Accession period: Relevant scheme: 1 July 2013 to worker authorisation arrangments Croatia Answer questions 9.14 to 9.Version 04/15 Page 59 of 127 . a national of one of the countries listed below (‘accession states’). Accession state workers Complete this subsection if you are/were. EEA(PR) .B. and you or they were working for an employer during the relevant ‘accession period’ (defined below).20 below. unless you/they were exempt from that requirement. or your sponsor is/was. If you/they were not exempt. You must show that you/they were registered or authorised to do the work in question.

please complete the table below with details of any worker registration.9. worker authorisation. or other documents. why was this? Exempt or not otherwise required to register/obtain authorisation – go to 9. you/they held. at any point during the accession period.Version 04/15 Page 60 of 127 . when did you/your sponsor complete this 12-month D D period? M M Y Y Y Y 9.15 Did you/your sponsor work for an uninterrupted period of 12 months in accordance with one or more of the documents mentioned in the table above? Yes No If yes.14 If you or your sponsor worked for an employer during the relevant accession period.20 EEA(PR) . Continue on a separate sheet if necessary and enclose with your application.17 Worked without permission – go to 9. you/your sponsor worked without holding one of the documents listed in the table above. Name of document Reference number Date of application Date of issue Name of employer or category of employment authorised Worker registration card / certificate (EU8) Accession worker (‘purple’) card (EU2) Worker authorisation (‘purple’) registration certificate (EU1) ‘Yellow’ registration certificate issued to student allowing restricted work (EU1 or EU2) Other document permitting you/your sponsor to work (please specify) 9.16 If.

EU2 or EU1).g. as the member of a diplomatic mission or a member of such a person’s household) I/my sponsor was also a national of another EEA member state (not the UK or other accession state) I/my sponsor held a ‘blue’ registration certificate as a highly skilled person (EU2/EU1 only) I/my sponsor was a posted worker The employment lasted for less than 30 days (EU8 national only) Any other reason – please state EEA(PR) . or student I/my sponsor was the spouse. or child/grandchild (aged under 21 or dependent) of an accession state national who was working in accordance with an accession worker registration or authorisation document I/my sponsor was exempt from immigration control (e. or the unmarried or same-sex partner of a person with such leave (EU1 only) I/my sponsor was the family member of an EEA national who was not an accession state national and who was lawfully residing in the UK I/my sponsor was the family member of an accession state national who was in the UK as a self-employed person.9. self-sufficient person. or the unmarried or same-sex partner of a British citizen or settled person (EU1 only) I/my sponsor was the spouse. I/my sponsor had indefinite leave to enter or remain.Version 04/15 Page 61 of 127 .17 If you/your sponsor was exempt or not required to register/obtain authorisation. civil partner. please tick the relevant box(es) below to explain why. or leave to enter or remain which did not restrict my/my sponsor’s right to work I/my sponsor had leave to enter or remain which allowed me/my sponsor to do the work in question I/my sponsor had already completed 12 months’ uninterrupted legal employment I/my sponsor was the spouse or civil partner of a British citizen or settled person (exemption applies to EU2 or EU1 nationals only). civil partner. or child under 18 of a person who had leave to enter or remain which allowed that person to work (EU8.

• Section 15 if you are the relative (extended family member) of the sponsor named in section 4 and you strictly require their personal care on serious health grounds.Version 04/15 Page 62 of 127 . • Section 14 if you are the dependent relative (extended family member) of the sponsor named in section 4. or of their spouse/civil partner. 9. or of their spouse/civil partner. give details below: Date of issue: D D M M Y Y Y Y Document reference number: 9. • Section 13 if you are or were the dependent child. • Section 16 in all other cases.20 If you/your sponsor worked without permission at any time during the accession period (and were not exempt). for example.19 Give any further relevant details of how you were/your sponsor was exempt below. details of any relevant leave to enter or remain.18 Did you/your sponsor hold a residence permit/registration certificate (EU8 national) or ‘blue’ registration certificate (EU2/EU1 national) as an exempt person? Yes No If yes. parent or grandparent of the sponsor named in section 4. grandchild aged under 21) of the sponsor named in section 4. This could include. civil partner or durable partner of the sponsor named in section 4. or a member of their household. give details below. Name of employer Date unauthorised work started Date unauthorised work ended Now go to— • Section 11 if you are or were the spouse. EEA(PR) . • Section 12 if you are or were the descendant (child.9. Continue on a separate sheet if necessary. how you/your sponsor obtained indefinite leave to remain or details of any relevant family member (if exempt on the basis of a family relationship). grandchild.

4 D D Self-employed Date the British citizen starting working or self-employment in the EEA state: M M Y Y Y Y EEA(PR) . and that British citizen exercised free movement rights as a worker or self-employed person in an EEA Member State other than the UK. B and C below. a registration certificate or residence card. I have not previously been issued with documentation under the Surinder Singh route but I completed five years’ continuous residence in the UK as the family member of the relevant British citizen ending on or after 1 January 2014. This is also known as the ‘Surinder Singh’ route. Details of the British citizen’s activity in the EEA state 10. Complete subsections A and B. Complete subsections A.Version 04/15 Page 63 of 127 . or was last issued with. 10. or entered the UK with a valid EEA family permit.Family member of a British citizen (‘Surinder Singh’ route) Complete this section if you’re applying for a document certifying permanent residence or permanent residence card because you’ve lived in the UK for a continuous period of five years as the family member of a British citizen. Make sure you have also given details of your previous document in section 5.Section 10 .3 What was the British citizen doing in the EEA state? Working 10. or an EEA family permit under the Surinder Singh route.1 Tick which of the following applies and complete the relevant subsections as directed I have. but I had completed five years’ continuous residence in the UK as the family member of the relevant British citizen before 1 January 2014. residence card. A. as the family member of the relevant British citizen.2 What is the EEA state in which your British citizen family member exercised their free movement rights? 10. I have not previously been issued with a registration certificate. and that document has not since been revoked or cancelled. Complete subsections A and B below.

10.5
D D

Date the British citizen stopped working or self-employment in the EEA state:
M M

Y Y Y Y

Please provide further information about the British citizen’s work, self-employment or other
activity in the EEA state below.

(1)

Employment

10.6

Their tax, social security or equivalent reference number:

10.7 Please list all of the British citizen’s employment in the EEA state, starting with the most
recent. Continue on a separate sheet if necessary.
Name and address of
employer

Job title/
position held

Number
of hours
normally
worked
each week

Salary or
wage*

Start and end date of
employment

* Please give the ‘gross’ figure (i.e. before deductions for tax, national insurance (or equivalent)
and any other deductions). Say if the amount is per week, month or year.

(2) Self-employment
10.8

Name of the British citizen’s business:

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10.9

Address of the business:

Postcode
10.10

Website address of business (if applicable):

10.11

The British citizen’s role in the business – please tick:

Sole trader

Partner in a business or limited company

Company director

Other – please state:

10.12 Type of business (for example, what product(s) the business made or sold, what services
they provided, etc):

10.13

Did the British citizen own, rent or lease his/her own business premises?

Yes, rented/leased

Yes, owned

Other – please state:

10.14
state:

The British citizen’s tax, social security, or other relevant reference number(s) in the EEA

Note: you must provide evidence of the British citizen’s activity in the EEA state. See section 18
for details.
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(3) Other activity
10.15 Use the box below to explain what the British citizen was doing during any period
when they were not working or self-employed in the EEA state, or to give any further relevant
information about their work or self-employment not mentioned above. This could include, for
example, periods when they were unable to work due to an illness or accident, or they were
involuntarily unemployed and looking for work or doing vocational training.
Please also provide any relevant evidence (e.g. proof of receipt of state benefits, proof
incapacity, etc) – see section 18.

B.
10.16
Yes

Residence in the EEA Member State
Are you married to or in a civil partnership with the relevant British citizen?
– go to 10.17

No

– go to question 10.19

10.17 If you are the spouse or civil partner of the relevant British citizen, were you married to/
in a civil partnership with the British citizen while the British citizen was living in the EEA state
named above?
Yes

No

Note: give full details of your relationship in section 11.
10.18 If you have answered yes to question 10.17, did you live with the British citizen in the
EEA state named above?
Yes

No
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any other family members) Ownership of property (please tick for each address) Owned by you/the British citizen Rented by you/the British citizen Provided by employer/ friend/relative Other – please specify: Owned by you/the British citizen Rented by you/the British citizen Provided by employer/ friend/relative Other – please specify: Owned by you/the British citizen Rented by you/the British citizen Provided by employer/ friend/relative Other – please specify: EEA(PR) . You must also provide relevant evidence – e. utility bills. the British there (from/to) citizen.Version 04/15 Page 67 of 127 . the British citizen.g. Address Who lived there Dates lived (you. mortgage statements. Start with the most recent address and continue on a separate sheet if necessary. etc.10. See section 18 for details. and any other family members (if applicable) lived while the British citizen was working or self-employed in the EEA state. tenancy agreements.19 Please give details of where you.

Integration in the EEA Member State 10. and provide supporting evidence where possible. evidence of attendance at language classes) • if you had any children or grandchildren living with you in the EEA state.Version 04/15 Page 68 of 127 . If not applicable. investments) • evidence of learning or speaking the language of the EEA state (e. give details of any absences from the EEA state by you. EEA(PR) .g. write N/A You: D D M M Y Y Y Y Other family members: C. qualifications. bank account. the British citizen or your family members. Continue on a separate sheet if necessary. the British Country or citizen.21 Date the British citizen returned to live in the UK: D D Date of departure M M Date of return Number of days Y Y Y Y 10.22 If you or your family members lived with the British citizen in the relevant EEA state. date you/they returned to live in the UK. This could include things like: • details of financial commitments in the EEA state (for example. family members) countries visited 10.23 Use the box below to provide any other information which you feel demonstrates that the relevant British citizen transferred the centre of his or her life to the EEA Member State.20 In the table below. etc. mortgage. Who was absent (you. details of any nursery/school/college/university they attended • membership of any social groups or sports clubs. rental agreement.10.

parent or grandparent) of the British citizen.Version 04/15 Page 69 of 127 . EEA(PR) . Then go to section 17 (personal history).• details of any community activities undertaken in the EEA state • any other relevant information. Now go to— • Section 11 if you’re the spouse or civil partner of the British citizen • Section 12 if you’re the descendant (child or grandchild aged under 21) of the British citizen • Section 13 if you’re a dependent family member (child or grandchild aged over 21.

civil partner or durable partner of the sponsor Complete this section if you’re applying for a document certifying permanent residence or permanent residence card because you are (or were) the spouse. Complete all subsections (A to F). I was the spouse or civil partner of the (EEA national) sponsor and I have retained my right of residence following divorce. and I’ve held valid residence documentation as their partner throughout the relevant qualifying period.5 Are you and your sponsor related outside of your marriage/civil partnership/relationship? Yes No If yes.Spouse. I was previously the durable partner of the relevant EEA national and held valid residence documentation as their partner. when did you first meet your sponsor? 11.2 Yes Have you met your sponsor? No If yes. annulment or dissolution of the marriage/civil partnership.4 When did your relationship begin? 11. E and F.1 Please tick which applies to you: I’m currently the spouse or civil partner of the sponsor. I’m currently the unmarried or same-sex partner of the relevant EEA national. I’m in a durable (lasting) relationship with them. How and when your relationship began 11. 11. civil partner. B.Section 11 . how are you related? EEA(PR) . or durable partner of the person named in section 4 of this form (your ‘sponsor’). Complete subsections A to D. Complete all subsections (A to F). A.Version 04/15 Page 70 of 127 . or my spouse/civil partner has died. C. Complete subsections A.3 Where did you first meet your sponsor? 11. and I’m now married to or in a civil partnership with them.

14.8 Were you in a relationship with each other when you started living together? Yes No 11.9 If you have lived with your sponsor at an address other than the address given in section 1 of this form during the relevant qualifying period. Continue on a separate sheet if necessary.Version 04/15 Page 71 of 127 . then go to 11.7 to 11.9.10 to 11.7 When did you start living together? 11. Postcode From D D M M Y Y Y Y To D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y Postcode From D D M M Y Y Y Y To Postcode From D D M M Y Y Y Y To EEA(PR) . please list them below.6 Do you and your sponsor currently live together? Yes answer questions 11. then go to 11.B.15 If you’re currently living together: 11. Contact with your sponsor and living arrangements 11.15 No answer questions 11.

EEA(PR) .10 Why do you not currently live with your sponsor? 11.11 Have you ever lived with your sponsor within or outside the UK? Yes No If yes.15 Do you intend to live with your sponsor permanently in the UK? Yes No If no.If you’re not currently living together: 11.13 When did you last see your sponsor? 11. please provide details of when and where you previously lived with your sponsor 11.12 How often do you see (meet) your sponsor? 11. please explain why not.14 How do you keep in touch with your sponsor? 11.Version 04/15 Page 72 of 127 .

17. from a previous or other relationship)? Yes 11. Child 1 Child 2 a) Full name of child b) Is this child applying at the same time with you? c) Date of birth yes D D no M M Y Y Y Y D D yes no M M Y Y Y Y d) Place of birth EEA(PR) .20 If you have answered yes to questions 11. 11. make a copy of this table.17. or subsection E if you’re the durable partner of the sponsor).19 No Does your sponsor have any children living in the UK of whom you are not the parent? Yes No If you have answered no to questions 11. or provide the information on an additional piece of paper.11.19. 11. Note: if your children wish to apply for a document certifying permanent residence or permanent residence card.19. 11.e. complete the table below with details of any children of yours.18 Do you have any children of whom your sponsor is not the parent (i. If there are more than two children. they will need to complete their own application form and pay the fee. go to subsection D (if you’re the current or former spouse of the sponsor).17 Where do you plan to live together in the UK? Children Do you and your sponsor have any children together? Yes No 11. or of your sponsor. and include with your application. 11.Version 04/15 Page 73 of 127 .18 and 11.16 C.18 or 11.

their nationality and their level of contact or parental responsibility. provide details of the other parent. where they live. please state the other nationality or nationalities) g) Passport.Version 04/15 Page 74 of 127 . Include Name. travel document or national identity card i) Issuing authority j) Date of issue k) Date of expiry l) List all languages that the child is familiar with m) If your child was not born here when did your child enter the UK? n) How long has this child lived in the UK? o) Does this child live with you at the address provided in 1. EEA(PR) .23? p) Has your child ever lived in another country? If yes please provide details of when and where they lived q) Who is financially responsible for this child? r) If your sponsor is not the other parent of this child. travel document or national identity card number h) Place of issue of passport.e) Gender male female male female f) Nationality (if they have more than one nationality.

11. provide details of where the child/children lives(s).22 Is your sponsor financially responsible for supporting anyone else.Version 04/15 Page 75 of 127 . Marriage or civil partnership 11. other than you and any children mentioned above? Yes No If yes.25 Where (in what town/city and country) did your wedding or civil partnership ceremony take place? EEA(PR) .24 Date of your marriage or civil partnership D D M M Y Y Y Y 11. Include the reason why they do not live with you and your sponsor.23 When did you decide to marry or form a civil partnership with your sponsor? 11.21 If you have answered no to question (o) in the table above. give details below: D. 11. who they live with and their relationship with that person.

present at the ceremony.please state: 11.28 If you were not.g. Other relationships 11.e.30 Have you or your sponsor been married. we were both present at the ceremony I was present at the ceremony but my sponsor was not My sponsor was present at the ceremony but I was not Neither I nor my sponsor was present at the ceremony 11.11.29 Do you or your sponsor currently have another spouse or civil partner.Version 04/15 Page 76 of 127 . or an unmarried or a same-sex partner with whom you or they are in a durable relationship? Yes No 11.27 Were you and your sponsor both present at the ceremony? Please tick: Yes. please say why and explain where you were/your sponsor was at the relevant time: E. conducted in a place of religious worship) Customary Civil (e.26 What type of ceremony was your wedding or civil partnership? Religious (i. conducted in a registry office) Other . in a civil partnership. or in a long-term relationship before your current relationship? Yes No EEA(PR) . or your sponsor was not.

11.31 If you have answered yes to either of the above questions, please give details of all other
current or previous marriages/civil partnerships/relationships in the table below. If you have
answered no to both questions, go to subsection F.
In these questions, ‘partner’ includes spouse, civil partner, unmarried partner or same-sex
partner.
You (if applicable)

Your sponsor (if applicable)

a) Full name of other or
former partner
b) Nationality of other or
former partner
c) Date of marriage or civil
partnership (if applicable)
d) Place of marriage/civil
partnership (if applicable)
e) Date of divorce, annulment
or dissolution (if applicable)
f) If not married or in a civil
partnership, how long the
relationship lasted
g) Date of death of the former
partner (if applicable)
If there is more than one relationship, please provide details on a photocopy of this page and
enclose it with this form.

F. Additional questions
11.32

What languages do you and your sponsor speak well?

Language(s) spoken by you

Language(s) spoken by your sponsor

11.33 What language(s) do you and your sponsor normally use to communicate with each
other?

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11.34

Do you and your sponsor have any shared financial responsibilities?

Yes

No

If yes, please provide details below:

11.35 If you wish to add any further information about your circumstances, please use the box
below. If you have no further information to add, leave it blank.

Now go to • Section 17 if your sponsor is a British citizen, or
• Section 16 in all other cases.

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Section 12 - Descendant (child or grandchild) aged
under 21
Complete this section if you’re applying for a document certifying permanent residence or
permanent residence card as a descendant aged under 21.
‘Descendant’ means—
• the dependent child of the sponsor named in section 4, or of their spouse or civil partner, if the
sponsor is, or was an EEA national who only has a right to reside as a student, or
• in other cases, the child or (great-)grandchild of the sponsor, or of the sponsor’s spouse or
civil partner.
In both cases, you must be under 21 years of age.
Grandchildren of EEA national students must qualify as ‘extended’ family members and should
complete section 14 or 15, even if they’re aged under 21.
In other cases, descendants who are aged 21 or over must be dependent on the sponsor, or on
the sponsor’s spouse or civil partner, and must complete section 13 instead.
12.1 Please give details of your parents, as recorded on your birth certificate, legal adoption
order, or UK parental order.
Mother/parent 1

Father/parent 2

Full name
Date of birth
Nationality
Note: you must include the relevant birth certificate, parental order or adoption order.
12.2
Yes

Do you currently live with both parents named in question 12.1?
No

12.3 If you have answered no to question 12.2, and you are under the age of 18, please
explain who you normally live with and the reasons for this below. You must also provide
relevant supporting evidence (see section 18).

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7 Yes Are you currently working (including self-employment) in the UK? No If yes. please give details below: Name and address of employer or business Number of hours normally worked each week Wages per week/ month* (please specify) Date this employment started * Give the figure before any deductions for tax.Version 04/15 Page 80 of 127 .6 Have you ever lived in any country other than the UK? Yes No If yes.4 Who is financially responsible for you? 12.5 Which languages are you familiar with? 12. please give details below: 12. EEA(PR) .12. national insurance or other regular deductions.

12. or vocational training)? Yes No If yes.8 Are you currently in education (including school. university. EEA(PR) . college.Version 04/15 Page 81 of 127 . please give details below: Name and address of educational establishment Name of course Course start date or qualification Course end date Now go to • Section 17 if your sponsor is a British citizen • Section 16 in all other caes.

This must be the relevant EEA national or British citizen named in section 4. parent. ‘Dependent’ means that you need the financial help of your sponsor to meet your essential needs. Your sponsor 13. You must be the: • dependent child or (great-)grandchild aged 21 or over of the sponsor (or of their spouse or civil partner). and you’re their grandchild.Section 13 .Dependent family member (child. or their spouse or civil partner.1 Is your sponsor: (a) The EEA national or British citizen named in section 4 (b) The EEA national’s or British citizen’s spouse or civil partner (c) Both If you have ticked (b) or (c). you must qualify as an ‘extended’ family member and should complete section 14 or 15 instead. or both. In this section— ‘Sponsor’ means the person who gives you financial support. grandchild.2 How long have you been dependent on your sponsor? EEA(PR) .Version 04/15 Page 82 of 127 . Note: if your sponsor is an EEA national who only has a right to reside as a student. please give details of the sponsor’s spouse or civil partner below: Full name: Date of birth: D D M M Y Y Y Y Nationality: 13. grandparent) Complete this section if you’re applying for a document certifying permanent residence or a permanent residence card as the dependent family member of the sponsor named in section 2. or • dependent parent or (great-)grandparent of the sponsor (or of their spouse or civil partner). parent or grandparent.

EEA(PR) . please say how much and how often: 13. a company or state pension. national insurance or other regular deductions. please give details below: Name and address of employer or business Number of hours normally worked each week Wages per week/ month* (please specify) Date this employment started * Give the figure before any deductions for tax.Your income 13. and so on. Continue on a separate sheet if necessary.Version 04/15 Page 83 of 127 . income from rental property. in the UK or overseas. This could include. give details (including how much and how often) below: 13.3 Yes Does your sponsor regularly give you money? No If yes.6 Please give details in the table below of any other regular source of income or capital you have.4 Yes Do you receive financial assistance from any other relative or friend? No If yes. investments. for example.5 Yes Are you currently working (including self-employment) in the UK? No If yes. savings. 13.

9. If you need to give more details. Outgoing Amount per month Who pays (e. your sponsor. mortgage or other payment for this accommodation? Yes No If yes. you can use the box at the end of this section or provide them on a separate sheet if necessary.9 Please complete the table below with details of your regular outgoings and expenditure. a relative/friend) Rent/mortgage Gas Electricity Water rates Council tax Phone (mobile and/or landline) Food Clothing EEA(PR) .Source of income How much you receive How often you receive it Accommodation 13. If your sponsor or another relative or a friend helps you with these. you.g.Version 04/15 Page 84 of 127 . Outgoings and expenditure 13.7 Do you currently live with your sponsor? Yes 13. please give details in the third column.8 No Do you pay any rent. give details in question 13.

10 Please give any other relevant information about how you are dependent. if none. write ‘none’): 13. dental treatment.Medical care (including prescriptions. medical insurance.Version 04/15 Page 85 of 127 . Now go to • Section 17 if your sponsor is a British citizen • Section 16 in all other cases EEA(PR) . This could include any further information about your financial circumstances or details of any emotional or physical support you receive from your sponsor. please leave this blank. etc) Other essential outgoings (please specify. If you have no further information to add. optical care.

and you: • were dependent on the EEA national or were a member of their household before you came to the UK.Extended family member (relative) who is dependent on the EEA national or is a member of their household Complete this section if you’re applying for a document certifying permanent residence or permanent residence card because you’re a relative of the relevant EEA national.Section 14 . If you have not. please say how much. Your current status 14. residence card or EEA family permit) as the relevant EEA national’s extended family member throughout the relevant qualifying period. you will not qualify for permanent residence. member of their household No Income 14. and • since entering the UK. dependent Yes. you should complete form EEA(EFM) instead. Yes. or of their spouse or civil partner. Note: you must have held valid residence documentation (registration certificate. how often and for how long: EEA(PR) . have continued to be dependent on the EEA national or be a member of their household. If you wish to apply for a registration certificate or residence card.2 Yes Do you regularly receive money from your sponsor? No If yes.1 Are you currently dependent on your sponsor or are you a member of your sponsor’s household in the UK ? Tick more than one if relevant.Version 04/15 Page 86 of 127 . ‘sponsor’ means the relevant EEA national named in section 4 of this application form and of whom you are a relative. In the rest of this section.

4 Please give details in the table below of any other regular source of income or capital you have. This could include. is this property owned or rented by the EEA national. investments.3 Yes Do you regularly receive money from any other relative or friend? No If yes. how often and for how long: 14. if applicable)? Relationship to you EEA(PR) .14. income from rental property. and so on. please say how much.6 If you have answered yes to 14. savings. Continue on a separate sheet if necessary. income from employment or self-employment. from the UK or elsewhere.5 Yes Do you currently live with your sponsor? No 14. state benefits. Source of income How much you receive How often you receive it Accommodation 14. mortgage or other payment? Yes 14. for example. or is the EEA national the person mainly responsible for paying any rent.5.7 Name No Who else lives with you (apart from your sponsor. a company or state pension.Version 04/15 Page 87 of 127 .

g. you. etc) Other essential outgoings (please specify. your sponsor. optical care. medical insurance.9 Please complete the table below with details of your regular outgoings and expenditure. write ‘none’): EEA(PR) . a relative/friend) Rent/mortgage Gas Electricity Water rates Council tax Phone (mobile and/or landline) Food Clothing Medical care (including prescriptions.14. please give details in the third column. If you need to give more details. you can give these in the box at the end of this section or provide them on a separate sheet and enclose with the application. If the EEA national or another relative or a friend helps you with these.9 Outgoings and expenditure 14.Version 04/15 Page 88 of 127 . dental treatment. give details in 14. mortgage or other payment for this accommodation? Yes No If yes. Outgoing Amount per month Who pays (e.8 Do you pay any rent. if none.

10 Do you have any ongoing health conditions. If you have a serious health condition which strictly requires the personal care of the EEA national. EEA(PR) . This could include: • further information about your financial circumstances before or after coming to the UK • details of any emotional or physical support you receive.Version 04/15 Page 89 of 127 . including physical or mental conditions? Give details below. from the EEA national • your family circumstances in your home country • details of any compelling or compassionate circumstances which would make it difficult for you to live in your home country without the EEA national’s support • any other relevant information.Other information 14. or of their spouse or civil partner. Continue on a separate sheet if necessary and enclose it with the application. or have received. Now go to section 16. 14. you should consider completing section 15 instead.11 Please give any other relevant information in the box below to show how you are dependent on your sponsor.

or preparing food for yourself. If you wish to apply for a registration certificate or residence card. you will not qualify for permanent residence.2 How long have you had this (these) health condition(s)? 15.4 Are you able to care for yourself on a daily basis – that is.Extended family member (relative) who strictly requires the personal care of the EEA national. and you strictly require their personal care on serious health grounds. on serious health grounds Complete this section if you’re applying for a document certifying permanent residence or permanent residence card because you’re a relative of the relevant EEA national named in section 4.1 What is the nature of your health condition(s)? 15.Section 15 . you should complete form EEA(EFM) instead.Version 04/15 Page 90 of 127 . or of their spouse or civil partner. 15. Note: you must have held valid residence documentation (registration certificate. undertake daily tasks. such as washing and dressing yourself. or of their spouse or civil partner. without the help or support of anyone else? Yes No If no. residence card or EEA family permit) as the relevant EEA national’s extended family member throughout the relevant qualifying period. please say which daily tasks you have difficulty with: EEA(PR) .3 How long is (are) the health condition(s) expected to last? 15. If you have not.

Version 04/15 Page 91 of 127 .5 Who currently provides you with the majority of your care? a) The relevant EEA national b) The EEA national’s spouse or civil partner c) Both d) Someone else 15.6 If you have ticked (b).5 and 15.7 Please describe the care they provide you with and how often 15. nationality and date of birth of the other person. please give the name. please provide details below EEA(PR) .6 above? Yes No If yes.8 Do you receive any care from any other person or organisation (for example. please also say what their relationship is to you. social services) not mentioned in questions 15.15. (c) or (d). Full name Date of birth Nationality Relationship to you 15. If you have ticked (d).

did anyone else (or any organisation. paid or unpaid. please use the box below.15. EEA(PR) . please give details below and explain why the arrangement stopped (if it stopped) 15. Continue on a separate if necessary and enclose it with the application. please give details below: Name and address of employer or business Number of hours normally worked each week Wages per Date this week/month* employment (please specify) started *Give the figure before any deductions for tax.9 Before the EEA national (or their spouse or civil partner) started caring for you. such as social services) provide care? Yes No If yes.11 If you wish to provide any further information about your circumstances. Now go to section 16.Version 04/15 Page 92 of 127 . national insurance or other regular deductions. 15. in the UK? No If yes.10 Yes Are you currently doing any work. employed or self-employed.

2 If you have answered yes.Version 04/15 Page 93 of 127 . or that your sponsor is claiming or has claimed since you have lived in the UK. each week/month and for how long the benefit has been paid. please complete the table below to show the amount you/your sponsor receive(s). or have claimed.Public funds (state benefits) This section asks for information about any public funds or state benefits (also known as ‘social assistance’) you are claiming. 16. Note: you do not have to complete this if you’re the family member of a British citizen and applying in the ‘Surinder Singh’ category (see section 10). any of the public funds or state benefits listed in the table at 16. since living in the UK. or have you/has your sponsor claimed.Section 16 .1 Are you/is your sponsor claiming.2 below? Yes No 16. Benefit Who receives it Amount you/ they receive each week/ month (please specify frequency) Date you/ they started receiving this benefit Date you/ they stopped receiving this benefit (if you/ they no longer receive it) Attendance allowance Carer’s allowance Child benefit Child tax credit Council tax benefit EEA(PR) . or received.

Council tax reduction Disability living allowance Employment and support allowance – income-related (workrelated activity group) Employment and support allowance – income-related (support group) Employment and support allowance – contribution-based (work-related activity group) Employment and support allowance – contribution-based (support group) Housing benefit Homelessness and housing assistance Income support EEA(PR) .Version 04/15 Page 94 of 127 .

Jobseeker’s allowance – income-based Jobseeker’s allowance – contribution-based Personal independence payment Severe disablement allowance Social Fund payment State pension credit Working tax credit Universal credit EEA(PR) .Version 04/15 Page 95 of 127 .

16. please use the box below. EEA(PR) .3 If there are any benefits not in the list above that you have/your sponsor has claimed. Now go to section 17. or if you wish to provide any other information.Version 04/15 Page 96 of 127 .

17. Note: We will carry out criminal record checks on all applicants and dependants. genocide. Information given will be checked with other agencies.go to question 17.Personal history This section asks you about any criminal convictions you have.Version 04/15 Y Y Y Y Page 97 of 127 . If you have received more than two convictions. It is an offence under section 26(1)(c) of the Immigration Act 1971 to make a statement or representation which is known to be false or is not believed to be true. Criminal conviction 1 Name under which you were convicted Country where convicted Nature of the offence Sentence given Date sentenced D D M M EEA(PR) . crimes against humanity or terrorism. If you fail to answer all of these questions as fully and accurately as possible. This includes road traffic offences but not fixed penalty notices (such as speeding or parking tickets) unless they were part of a sentence of the court.2 Please give details below for each criminal conviction. This includes all drink-driving offences.continue below No . your application may be refused. starting with the most recent one. In accordance with section 56A of the UK Borders Act 2007 you are required to disclose all spent or unspent convictions.Section 17 . any civil judgments or civil penalties made against you and details of any involvement you may have had in war crimes.1 Have you been convicted of any criminal offence in the UK or any other country? Yes . please photocopy this page and enclose it with this form.

what was the length of the prison sentence imposed (in months)? months Criminal conviction 2 Name under which you were convicted Country where convicted Nature of the offence Sentence given Date sentenced D D M M Y Y Y Y If you were sentenced to a period of imprisonment. EEA(PR) .2 Do you have any civil judgments against you or any civil penalty under the UK immigration acts? Yes continue below No go to question 17. If you have received more than two civil judgments and/or civil penalties under the UK immigration acts.Version 04/15 Page 98 of 127 . starting with the most recent one. please photocopy this page and enclose it with this form. what was the length of the prison sentence imposed (in months)? months 17.3 Give details for each civil judgment or any civil penalty under the UK immigration acts.If you were sentenced to a period of imprisonment.

Version 04/15 go to question 17. For help in answering these questions. Provide more details on a separate sheet of paper if necessary and submit it with your application.4 In either peace or war time. crimes against humanity or genocide? Yes Please provide details: No EEA(PR) . please see the definitions at the end of this section.3 Have you ever been charged or indicted in any country with a criminal offence for which you have not yet been tried in court? Yes Please provide details: No go to question 17. or been suspected of involvement in. 17.Details of judgment or civil penalty 1 Date of judgment or civil penalty D D M M Y Y Y Y D D M M Y Y Y Y Country where judgment made Details of judgment or civil penalty 2 Date of judgment or civil penalty Country where judgment made You must answer the following questions even if you have answered that you have not been convicted of any criminal offence in the UK or any other country.5 Page 99 of 127 . have you ever been involved in.4 17. war crimes.

8 Have you ever engaged in any other activities which might indicate that you may not be considered to be a person of good character? Yes Please provide details: No EEA(PR) .8 17. or given support to.7 17.9 Page 100 of 127 .Version 04/15 go to question 17.5 Have you ever been involved in.6 17. an organisation which has been associated with terrorism? Yes Please provide details: No go to question 17. by any means or medium.7 Have you ever.6 Have you ever been a member of. expressed views that justify or glorify terrorist violence or that may encourage others to terrorist acts or other serious criminal acts? Yes Please provide details: No go to question 17. supported or encouraged terrorist activities in any country? Yes Please provide details: No go to question 17.17.

cultural or family ties Definitions The following information provides guidance on actions which may constitute war crimes.9 Please state what ties you have with: • the country where you were born • any other country whose nationality you hold • any country where you have lived for more than 5 years You should tell us about any family friends. severe deprivation of liberty in violation of fundamental rules of international law and enforced disappearance of persons. Genocide Acts committed with intent to destroy. the intentional targeting of civilians and the taking of hostages. EEA(PR) . directed against any civilian population with knowledge of the attack.gov. or other connections with that country: Country Social. Crimes against humanity Acts committed at any time (not just during armed conflict) as part of a widespread or systematic attack.uk/ukpga/2001/17 or purchased from The Stationery Office (telephone 0870 600 5522). torture.17. racial or religious group. crimes against humanity. This includes an internal armed conflict and an international armed conflict. The full definitions of war crimes. extensive destruction of property not justified by military necessity. The types of acts that may constitute a war crime include wilful killing. legislation. crimes against humanity and genocide can be found in Schedule 8 of the International Criminal Court Act 2001 at www. This would include offences such as murder. War crimes Grave breaches of the Geneva Conventions committed during an armed conflict. in whole or in part. rape. torture. or terrorist activities. genocide. unlawful deportation. ethnical. This guidance is not exhaustive. It is the your responsibility to satisfy yourself that you are familiar with the definitions and can answer the questions accurately. a national.Version 04/15 Page 101 of 127 .

Terrorist activities
Any act committed, or the threat of action, designed to influence a government or intimidate the
public and made for the purposes of advancing a political, religious or ideological cause and that
involves serious violence against a person; that may endanger another person’s life; creates a
serious risk to the health or safety of the public; involves serious damage to property; is designed
to seriously disrupt or interfere with an electronic system.

Organisations concerned with terrorism
An organisation is concerned with terrorism if it commits or participates in acts of terrorism;
prepares for terrorism; promotes or encourages terrorism (including the unlawful glorification of
terrorism); or is otherwise concerned in terrorism.

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Section 18 - Documents and evidence
You must submit proof of your identity and nationality, proof of your sponsor’s identity, nationality
and status (if relevant), and proof that you have acquired permanent residence. If you do not,
your application may be delayed or refused.
This section provides guidance on what documents to submit.
Unless otherwise stated, please send original documents only. Photocopies are not acceptable.
If you’re unable to send the original, please explain why. We are unlikely to be able to approve
your application without sight of the original document.
Please also submit photocopies of all documents submitted as well as the original documents.
If you receive bank statements in online/electronic format only, ask your bank to stamp each
page with their official stamp.
If you wish to send any documents that are not in English or Welsh, you must get the document
translated by a qualified professional translator. Ask the translator or translation company to
confirm in writing on the translation:
• that it’s a ‘true and accurate translation of the original document’
• the date of the translation
• the full name and contact details of the translator or a representative of the translation
company.
Please tick the relevant boxes below to show what documents (and, where relevant, how many
of each) you’re submitting. If you’re submitting any documents not listed in the relevant section,
please list them at under ‘other evidence’ at Annex B.

Section 1 – Your personal details

How
many?

Photographs
2 passport sized photographs with your name written on the back of each and
which conform to the standards on www.gov.uk/photos-for-passports
Proof of your identity and nationality
Your valid passport or travel document, or
Your valid national identity card (EEA national only)
Make sure that you have signed your passport.
If you’re not able to submit a valid passport or national identity card, you must explain
why not and submit any alternative evidence of your identity and nationality (see also
section 1.17).
Alternative evidence submitted - please list:

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Section 2 - About your application
Complete this section as required.

Section 3 – Replace or renew your permanent residence document

How
many?

Your previous permanent residence document (if available), or
Police lost property report or confirmation of crime reference number if the
document has been lost or stolen, or
Any other relevant evidence regarding the whereabouts of your permanent
residence document – please state:

Proof of your residence in the UK since you were issued with your permanent
residence document – see section 5 below for examples of documents and list
them in Annex B below.

Section 4 – Your sponsor (if you have one)

How
many?

Passport photograph of your sponsor
At least 1 passport sized photograph of your sponsor with their name written
on the back and which conforms to the standards on www.gov.uk/photos-forpassports
Proof of your sponsor’s identity and nationality
Your sponsor’s valid passport, or
Your sponsor’s valid national identity card
Make sure that they have signed their passport, if required.
If you’re not able to submit a valid passport or national identity card for your sponsor, you must
explain why not and submit any alternative evidence of their identity and nationality (see also
section 4.16).
Alternative evidence submitted:

Proof of your relationship to your sponsor
If you’re a family member or relative of the sponsor named in section 4, you must
show how you’re related to them by providing relevant birth, adoption, marriage or civil
partnership certificates. Examples are listed below for the main types of relationship.
‘Full birth certificate’ means an official birth certificate which shows the name of the
child, the child’s parent(s), date of birth and place of birth.
If you’re the unmarried partner of the sponsor, see section 11.
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your grandchild) Brother/sister of the EEA national sponsor Your full birth or adoption certificate The relevant EEA national’s (i.e. rather than of the EEA national. the sponsor’s) full birth or adoption certificate Grandparent of the sponsor Full birth or adoption certificate of your child (i. your brother’s/sister’s) full birth or adoption certificate Aunt/uncle of the EEA national sponsor Your full birth or adoption certificate Full birth or adoption certificate of your brother or sister (i. then you must submit the relevant combination of documents outlined above.Version 04/15 Page 105 of 127 .e.e.e.e. the parent of your EEA national nephew/niece) The relevant EEA national’s (i.e. your aunt’s/uncle’s) full birth or adoption certificate Family member or relative of the sponsor’s spouse or civil partner If you’re a relative of the sponsor’s spouse or civil partner. your cousin’s) full birth or adoption certificate Nephew/niece of the EEA national sponsor Your full birth or adoption certificate Full birth or adoption certificate of your mother/father (i.e. the parent of the relevant EEA national) The relevant EEA national’s (i.e.Spouse/civil partner of the sponsor Your marriage or civil partnership certificate Child of the sponsor Your full birth or adoption certificate Grandchild of the sponsor Your full birth or adoption certificate Full birth or adoption certificate of the sponsor (i. your nephew’s/niece’s) full birth or adoption certificate First cousin of the EEA national sponsor Your full birth or adoption certificate Full birth or adoption certificate of your mother/father (depending on whether the relationship is through your mother or father) Full birth or adoption certificate of your mother’s/father’s brother or sister (i.e.e. the brother/sister of the relevant EEA national) The relevant EEA national’s (i. the mother/father of the sponsor) Full birth or adoption certificate of the sponsor (i.e. your mother or father) Parent of the sponsor Your child’s (i. plus: EEA(PR) .

you must submit any other relevant evidence clearly showing the relationship. List that evidence below: Other evidence submitted: Section 5 – Residence in the UK and previous documentation How many? Previous passport. travel documents or EEA national identity cards you’ve held since you entered the UK Previous residence documentation EEA family permit Registration certificate Residence card Document certifying permanent residence Permanent residence card Derivative residence card Other – please state: EEA(PR) . or you otherwise cannot submit the documents listed above.Marriage or civil partnership certificate of the sponsor and their spouse or civil partner Other relationships or other evidence If you’re related to the sponsor in any other way.Version 04/15 Page 106 of 127 . travel document or national identity card Any previous passports.

If you’re applying as the spouse. Department for Work and Pensions. If you’re applying as the family member of an EEA national who has died or ceased activity.continued How many? Proof of your/your sponsor’s previous residence in the UK throughout the relevant qualifying period You must show that you and your sponsor (if applicable) have been living in the UK for the relevant period. you must also show that you and your sponsor were living in the UK before the ‘relevant date’ that is. TV Licensing Letters or other documents from your GP. DVLA. you must show you have been living together – see section 11 below. We recommend you submit at least 2 documents for each year of residence. appointments.Version 04/15 Page 107 of 127 . If you have not previously been issued with a registration certificate or residence card in this category. If you’re applying on the basis of 5 years’ continuous residence. for example HM Revenue and Customs. The documents should be spread evenly throughout the 5-year period and come from a variety of sources. the evidence must cover the 5-year period. home visits or other medical matters Bank statements/letters Building society savings books/letters Council tax bills or statements Electricity and/or gas bills or statements Water rates bills or statements Mortgage statements/agreement Tenancy agreement(s) Telephone bills or statements Other – please state: Section 6 – Family member of an EEA national who has died How many? Death certificate of the relevant EEA national EEA(PR) . annulment or dissolution (see section 8). If you’re applying on the basis of a retained right of residence. you must show that you and the EEA national were resident in the UK immediately before EEA national died or ceased activity. the date your sponsor died or left the UK. you must show you have been resident in the UK since you retained your right of residence. civil partner or durable partner of the sponsor. or the date of divorce. a hospital or other local health service about medical treatments.Section 5 – Residence in the UK and previous documentation . Letters or other documents from government departments or agencies.

g.5. such as a letter from a doctor/consultant or evidence of compensation received from the employer If you receive/your sponsor receives a pension paid in part or full by an institution in the UK. bank statements showing receipt of payments) Letter from the relevant employer confirming the date you/your sponsor retired EEA national is permanently incapacitated A letter from a doctor/consultant confirming your/your sponsor’s incapacity and that it’s expected to be permanent If the incapacity is the result of an accident or work or occupational disease. If you answered ‘yes’ to question 6.Proof of the relevant EEA national’s employment or self-employment before they died – see section 9 or Annex A below.Version 04/15 Page 108 of 127 . letter from the pension provider. evidence of this. utility or council tax bills for that property (see section 5 above for list of documents and list them in Annex B below) Section 8 – Retained right of residence How many? Subsection A or B: sponsor has died Death certificate for your sponsor Subsection B or C: child in education Letter from the school/college/educational establishment confirming enrolment and attendance by the relevant child Subsection C or D(2): parent with custody of child Custody or residence order Letter or statutory declaration from the sponsor agreeing to the arrangement EEA(PR) . who has ceased activity How many? EEA national has retired Proof of receipt of a state and/or company pension (e. evidence that your sponsor’s death was due to an accident at work or occupational disease. such as a letter from the pension provider and/or bank statements showing receipt of payments EEA national is now active in another EEA state Proof that you are/your sponsor is working or self-employed in another EEA state – see notes for section 9 or Annex A below for guidance on the type of documents you can submit Proof that you have/your sponsor has retained your/their residence in the UK – e. or family member of EEA national. mortgage statement or tenancy agreement. evidence of this.g. such as a letter from a doctor or consultant Section 7 – EEA national.

annulment or dissolution of marriage or civil partnership Divorce certificate.Version 04/15 Page 109 of 127 .Other – please state: Subsection D: divorce. (i) At least one of the following: An injunction. non-molestation order or other protection order made against the sponsor (other than an ex-parte or interim order) Evidence of a relevant court conviction against the sponsor Evidence of a police caution against the sponsor If the sponsor has not yet been convicted of an offence but there is a pending court case. you do not need to submit evidence of domestic violence again. we recommend you send at least one other document from list (i) or (ii) as evidence. you must submit at least one (more if possible) of the documents listed below: A medical report from a hospital doctor confirming that you have injuries consistent with being a victim of domestic violence A letter from a family practitioner who has examined you and is satisfied that your injuries are consistent with being a victim of domestic violence An undertaking given to a court that the perpetrator of the violence will not approach you A police report confirming attendance at your home as a result of a domestic violence incident A letter from a social services department confirming its involvement in connection with domestic violence A letter of support or report from a women’s refuge EEA(PR) . Note: in this case. Otherwise. if you’re claiming the marriage or civil partnership lasted 3 years before proceedings began to end it Subsection D(3): parent with access rights Relevant court order confirming details of the access arrangements Subsection D(4): domestic violence or other compelling circumstances Previous registration certificate or residence card issued in this category (if issued) Note: if you have previously been issued with a registration certificate or residence card on the basis of domestic violence. you must submit the relevant evidence below. decree absolute or dissolution order (or overseas equivalent) Divorce. you should submit evidence of this (such as a letter from the court confirming the date of the hearing). or overseas equivalent. dissolution or nullity petition. (ii) If you cannot submit any of the above documents.

you must show that your sponsor was an EEA national with permanent residence or qualified person at the relevant date – see section 9 below for guidance on the documents you must submit. or have retained your status as a worker or self-employed person.Version 04/15 Page 110 of 127 . or Evidence that your non-EEA family member meets the above conditions. If you have previously been issued with a registration certificate or residence card on the basis of a retained right of residence. self-employed or self-sufficient. please provide as much information about them and evidence as you can.Any other relevant evidence of domestic violence or compelling circumstances – please list: Subsection E: your sponsor’s status at the relevant date If you have not previously been issued with a registration certificate or residence card on the basis of a retained right of residence. Note: if you find it difficult to provide all of the relevant evidence because your sponsor has died or left the UK. since you retained your right of residence – see section 9 below for guidance on what documents to submit. birth certificate(s) – see notes for section 4 for guidance on how to prove you’re related to another person. or you’re no longer able to contact them. you do not have to submit evidence of your sponsor’s status again but we reserve the right to ask you for more information if necessary. EEA(PR) .g. Tick which applies below: I have previously been issued with a registration certificate or residence card on the basis of a retained right of residence I am providing evidence of my sponsor’s status at the relevant date – see section 9 Subsection F: your status at the relevant date Evidence that you have been working. and Proof of your relationship to your non-EEA family member (if relevant) – e.

P60s for each year in which you were/your sponsor was employed If you can’t get a letter from the employer (e. salary/wages. you must submit alternative evidence. If you’re applying under category D(1) (marriage or civil partnership lasted at least 3 years. you must show that you and your sponsor were living in the UK at the relevant date (i. I am providing evidence of my residence in the UK since the relevant date (see section 5 above). if the employer is no longer trading). with at least one year spent in the UK). Section 9 – Relevant EEA national’s activity as a qualified person How many? Subsection A: details of the relevant EEA national’s activity Your sponsor’s document certifying permanent residence if you answered ‘yes’ to question 9.Version 04/15 Page 111 of 127 . If you already have a registration certificate or residence card on the basis of a retained right of residence. See notes for section 5 above for examples of the types of document you can submit to prove your residence. you do not need to submit evidence of residence before the relevant date. However. a registration certificate or residence card on the basis of a retained right of residence. you must show you have lived in the UK since you were last issued with a registration certificate or residence card and have completed 5 years’ continuous legal residence in the UK (see section 5). If you’re applying under category A.Section 8 – Retained right of residence . annulment or dissolution). or was last issued with. such as: EEA(PR) .3. or date of divorce. or Proof that you have/your sponsor has been a qualified person – see below. I am providing evidence of my/my sponsor’s residence in the UK before the relevant date (see section 5 above). you must show that you had been living in the UK for at least one year before you sponsor died.e. immediately before your sponsor died or left the UK. and the reason the employment ended (if relevant) Wage slips and/or bank statements showing receipt of wages (this must cover each job you have/your sponsor has held during the relevant qualifying period). Employment Letter from each employer confirming the dates you/your sponsor worked for them. the evidence should cover at least one year’s residence in the UK. normal hours of work.continued How many? All subsections: proof of your and your sponsor’s residence in the UK If you have not previously been issued with a registration certificate or residence card on the basis of a retained right of residence. I have.g.

university or training provider confirming the title of course.or part-time. start and end dates of the course. qualification the course leads/led to. scholarship or bursary (Student only) A declaration. signed and dated by the relevant EEA national. the letter from the training provider must say whether and how the course is related to the previous employment. whether the course is/was full. or magistrate.please state: Self-employment Evidence of your/your sponsor’s self-employment – see Annex A to this section. confirming that they have/had sufficient financial resources to cover them and any family members living in the UK (if applicable) not to become a burden on the UK’s social assistance system during their period of stay in the UK as a student. EEA(PR) . college. This should be witnessed and counter-signed by a Commissioner for Oaths. and you/they became voluntarily unemployed. statutory sick pay or sickness-related benefits (if relevant) Study or vocational training Letter from the school.P45s Signed contract of employment Notice of redundancy Letter accepting resignation Letter of dismissal Employment tribunal judgment relating to the employment Other . Note: if you are/your sponsor is claiming to have retained your/their status as a worker.Version 04/15 Page 112 of 127 . Study or self-sufficiency (financial resources) Itemised bank statements Building society pass book Evidence of receipt of a pension Evidence of income from rental property Wage slips from lawful employment Evidence of income from lawful self-employment (Student only) Evidence of a grant. details of any work placements involved. public notary. Temporary incapacity A letter from a registered medical practitioner (general practitioner or consultant) confirming the nature of the illness or accident and how long the incapacity lasted or is likely to last Proof of any sick pay.

vocational or academic qualifications. You must also submit evidence of the sponsor’s finances as above. the Jobs and Benefits Office or Social Security Office (such as a letter from the relevant office and/or proof of receipt of relevant benefits) Proof of registration with a recruitment agency Copies of recent job applications Rejection letters from employers Invitations to job interviews If you are/your sponsor is still looking for work. evidence of relevant professional. Valid European Health Insurance Card (EHIC) (formerly form E111) issued by an EEA Member State (not the UK) Form S1 (formerly E106. E109. friend or other person has been financially supporting you/your sponsor. a signed and dated letter from that person confirming that they have been supporting you/your sponsor and for how long.If a relative. E121) Form S2 (formerly E112) Form S3 Looking for work Evidence of registration as a jobseeker with Jobcentre Plus. or relevant work experience (please list): If you are/your sponsor is still looking for work. evidence of any training you are/ your sponsor is doing or has done to improve your/their chances of finding work (please list): Any other relevant evidence of looking for work – please list below: Other periods not accounted for EEA(PR) . Any other relevant evidence of your/your sponsor’s financial resources – please state: Study or self-sufficiency (comprehensive sickness insurance) Schedule or other document from a private medical insurance provider outlining the level of cover Note: this must cover/have covered you/your sponsor/your family member(s) for the majority of risks while in the UK.Version 04/15 Page 113 of 127 .

salary/wage.g. payment of relevant taxes as a self-employed person. ‘blue’ registration certificate Any other document giving you/your sponsor permission to work – please state: Section 10 – Family member of British citizen (Surinder Singh) How many? Subsection A: your sponsor’s activity in the EEA state Employment Letter(s) from your sponsor’s employer(s) confirming the job title. Subsection B: residence in the EEA state EEA(PR) .Version 04/15 Page 114 of 127 . bank statements or other documents showing proof of income – see Annex A below for more examples of the types of document you can submit Other activity (if there are periods when your sponsor wasn’t working or selfemployed) Proof of temporary incapacity – e.If you completed 9. dates they worked for them. Proof of vocational training – e. hours they normally worked. such as proof of registration with the relevant tax authorities. doctor’s letter – see guidance for section 9. any other relevant evidence to show that you have or your sponsor has acquired permanent residence – please state: Subsection B: accession state workers Your/your sponsor’s worker registration card/certificate. letter from training provider – see guidance for section 9. worker authorisation (‘purple’) registration certificate. and reason for leaving Wage slips covering at least 3 months of employment and/or bank statements showing receipt of the wages Other evidence – please state: Self-employment Evidence that your sponsor was genuinely self-employed in the EEA state. Proof of receipt of job-seeking benefits and evidence of looking for work (if your sponsor was involuntarily unemployed) – see guidance for section 9.13. worker authorisation (‘purple’) card. invoices. ‘yellow’ registration certificate.g. contracts to provide services.

Version 04/15 Page 115 of 127 .g. Subsection C: integration in the EEA state (if you were required to complete this subsection) Evidence of any financial commitments in the EEA state – e.g. educational certificates.Proof that you and your sponsor (and any other family members. if relevant) lived in the EEA state. mortgage agreement. bank loans. etc) Evidence of membership of any social or community groups Other – please state: EEA(PR) . utility bills. letter from the relevant school/college. such as tenancy agreements. qualifications or proof of attendance at language classes If you had any children attending school or college in the EEA state. evidence of this (e.g. etc – see guidance for proving residence in sections 5. etc Evidence of speaking or learning the language of the EEA state – e.

The documents provided must be originals. You can rely on all or some of the same documents submitted in support of section 5. you may also provide items addressed to each of you individually if they show the same address for both of you. DVLA. Department for Work and Pensions. tell us the reasons for this and whether you stayed in contact with each other during this time. to cover a 5-year period living at the same address. and provide any relevant supporting evidence. and a further 5 items addressed to your partner. Examples of acceptable items are listed below.Section 11 – Spouse. spread evenly throughout the 5 years. We will consider each case on its individual merits but we recommend that you send at least 2 or 3 items addressed to you and your partner jointly for each year you have been living together (or since you were last issued with a registration certificate or residence card. The evidence should come from a variety of sources. provided they show that you were living together at the same address (20 items in total). you must show that you have been living together in a relationship similar to a marriage or civil partnership since you were last issued with a registration certificate or residence card in this category. the evidence should cover each address you have lived at. If you and your partner lived with relatives or friends for some or all of the relevant period. the items are not addressed to both of you. For example – you could send 10 items of correspondence in joint names at the same address. Please give an explanation on a separate sheet if you cannot provide the minimum number of items. civil partner or durable partner of the sponsor How many? Evidence of living together with your sponsor If you’re applying as the unmarried (durable) partner of an EEA national. you do not have to prove you have been living together but it will assist your application if you do. plus 5 items addressed to you. provided they clearly show you and your partner have been living together. For example. please provide a letter from the relative(s) and/or friend(s) confirming this. Letters or other documents from government departments or agencies. TV Licensing EEA(PR) . If you do not have enough items in your joint names. for example HM Revenue and Customs. If you’re applying as the current spouse or civil partner of an EEA national (or of a British citizen. from 4 or 5 different sources. If you did not live together for any part of the relevant period. addressed to you jointly. Photocopies are not acceptable. If you have changed address during this period. They should be addressed to you jointly or in both your names. if applicable). you should send a minimum of 10-15 items. if you’re applying under the Surinder Singh route). or they do not cover the relevant period.Version 04/15 Page 116 of 127 .

printouts of Skype (or similar) logs. list them below: Section 12 – Descendant under 21 How many? Evidence of your relationship to your sponsor (i.e. custody/residence order (if relevant) Previous marriages or civil partnerships If you have/your sponsor has previously been married or in a civil partnership. letters. home visits or other medical matters Bank statements/letters Building society savings books/letters Council tax bills or statements Electricity and/or gas bills or statements Water rates bills or statements Mortgage statements/agreement Tenancy agreement(s) Telephone bills or statements Photographs of you and your sponsor together – for example. on holiday or at a family celebration Evidence of how you have kept in contact with each other during periods in which you have not lived together – for example. appointments. birth or adoption certificate or parental order – see guidance for section 4 above) EEA(PR) . the relevant divorce certificate/decree absolute/dissolution order or equivalent Other relevant documents If you wish to submit any other relevant documents about your relationship. mobile phone bills showing you have contacted each other.Version 04/15 Page 117 of 127 . a hospital or other local health service about medical treatments. etc Any other evidence – please list: Children for whom you/your sponsor have parental responsibility Child’s birth or adoption certificate Parental order.Letters or other documents from your GP. printouts of emails or contact via social media.

etc Evidence of membership of EEA national’s household Proof that the EEA national owns or rents the property – e. Money transfer receipts from your sponsor to you Your bank statements showing receipt of money from your sponsor Your sponsor’s bank statements showing their financial circumstances Proof of any outgoings.g.g. utility bill. if relevant – e. mobile phone bill. mobile phone bill. medical bills.Version 04/15 Page 118 of 127 . e.3 and provide any relevant supporting evidence. parent. utility bills with your name on. or Letter from your parent(s) confirming that they consent to your current living arrangements Other evidence – please state: Section 13 – Dependent family member (child or grandchild aged 21 How many? or over. such as: Money transfer receipts from your sponsor to you Your bank statements showing receipt of money from your sponsor Your sponsor’s bank statements showing their financial circumstances Evidence of living in the same household as your sponsor. if relevant – e.g.How many? hold Evidence of financial dependency since you were last issued with a registration certificate or residence card. tenancy agreement naming you and your sponsor. mortgage agreement or tenancy agreement EEA(PR) .g. give the reasons for this in section 12. such as: Custody or residence order. grandparent) Evidence of your financial dependency. etc Any other relevant evidence – please list: Section 14 – Dependent relative or member of EEA national’s house.Parental responsibility (if you’re under 18) If you’re under 18 and not living with both parents named on your birth or adoption certificate or parental order.

tenancy agreement. a letter from that person or organisation giving details of this (please say what evidence you’re providing): Section 16 – Public funds / state benefits How many? Your or your sponsor’s bank statements showing receipt of the relevant benefit(s) Letter(s) from Jobcentre Plus. confirming receipt of the relevant benefit(s) Section 17 Complete this section as required. or NHS registration card showing your name and address (see section 5 for examples of documents you can send) Evidence of any medical condition you have and the care required (if relevant). Letter from a registered medical practitioner confirming your condition and what care you require Any other evidence – please list: Section 15 – Relative who strictly requires personal care How many? Evidence of your medical condition A detailed medical report from a registered medical consultant giving details of your medical condition and the type of care you require Evidence of the care you receive A letter or statement from your EEA national sponsor (or from their spouse or civil partner) confirming what care they provide you with and how often If you also receive medical care from anyone else or another organisation.g.Version 04/15 Page 119 of 127 . utility bill. Her Majesty’s Revenue and Customs. or the local authority. Department for Work and Pensions. e. EEA(PR) .g.Evidence that you and the EEA national live there – e.

written notification or printout of online confirmation) Self-assessment or tax calculations issued by HMRC (SA300 or SA302) P60s showing tax and national insurance paid for each relevant financial year b) National insurance documents – at least one of the following: Stamped receipts showing payment of class 2 or class 4 national insurance contributions (if paid in person at the post office or over the counter at the bank) Evidence from your/your sponsor’s bank statements showing payment of national insurance if paid by direct debit. If you have/your sponsor has not been trading long enough to pay tax or national insurance contributions or to send a self-assessment tax return. and these show payment of national insurance contributions through the PAYE system. letter or printout of online acknowledgement Notification from HMRC of your/their national insurance number and/or unique taxpayer reference number. national insurance and VAT a) Tax documents – at least two of the following: Copies or printouts of self-assessment tax returns (SA100) for the relevant period and evidence that they have been received by HMRC (e. send your/their: • CIS pay and deduction statements from the contractor showing your/their unique taxpayer reference (UTR) and CIS deductions.Version 04/15 Page 120 of 127 .Annex A – Evidence of self employment How many? 1. you must show that you/they have registered to pay these.g.g.) P60s covering the relevant financial years Any other written confirmation from HMRC of national insurance paid Certificate of small earnings exception issued by HMRC (if you/your sponsor did not earn enough to pay national insurance) If you are/were or your sponsor is/was a company director who receives/received wage slips. Proof of registration with Her Majesty’s Revenue and Customs (HMRC) and payment of relevant tax. Please send at least two of the following: Copy of form CWF1 or printout of online registration as a self-employed person with HMRC Evidence that HMRC has received the application – e. all relevant wage slips If you are/were or your sponsor is/was a self-employed subcontractor under the Construction Industry Scheme (CIS). EEA(PR) . (This should show on bank statements as ‘HMRC NI – DD’. and • at least one of the tax documents listed above.

or is expected to exceed. a copy of your/your sponsor’s statutory accounts for the relevant period with a letter from your/their accountant confirming gross/net profit for the relevant period P60s for the relevant period If you have/your sponsor has been a subcontractor under the Construction Industry Scheme. or otherwise provide evidence to show that you/they have access to the account If trading for more than 12 months. etc.Version 04/15 Page 121 of 127 .000 for 2013/14. with the net dividend amount and tax credit. in any relevant tax year. the VAT threshold (£79. you must send: • payslips covering the relevant period. listing in Yellow Pages. Evidence that the business is/was actively trading – at least two of the following: Copies of invoices for services provided Contracts to provide services Receipts for purchase of tools or business equipment Testimonials or references from clients. your/their CIS pay and deduction statement.c) Proof of VAT registration (if applicable): If. the business turnover exceeded. with their contact details (note: we will verify these documents) Examples of business advertising (such as flyers. receipts for payments. you must send: • dividend vouchers for dividends declared in your/your sponsor’s favour showing the company’s and your/your sponsor’s details. a certificate of VAT registration and the VAT return for the relevant financial year (a copy or print-out) confirming the VAT registration number 2. and • personal bank statement(s) showing that those dividends were paid into your/ your sponsor’s bank account 3.000 for 2014/15). £81. If the business is a limited company. exceeds. these must be on company-headed paper Personal bank statements showing receipt of payments for work carried out Business bank statements. You or your sponsor must be named on the account. Proof of earnings from self-employment – at least two of the following: Copies of invoices. and • personal bank statements showing receipt of wages If you are/were or your sponsor is/was a company director who receives/received dividends. together with one of the above documents If you are/were or your sponsor is/was a company director who receives/received a salary. online advertising. listing in trade magazines or on trade websites) Any other relevant evidence (please state): EEA(PR) .

Full valid driving licence if you are/were or your sponsor is/was required to drive as part of the business Security Industry Authority (SIA) licence if you are/were or your sponsor is/was a security guard or doorperson (‘bouncer’) Gas Safe registration card or reference number if you are/were or your sponsor is/ was a gas fitter Certificate issued by Environmental Health if you run/ran or your sponsor runs/ran a restaurant.4.g. Evidence of qualifications or professional registration if required for your or your sponsor’s trade For some businesses. or a printout of the return if it was sent electronically. Additional evidence if the business is a partnership Proof that the partnership is/was registered with Companies House (certificate of incorporation – certified copy is acceptable) If you are/were or your sponsor is/was the ‘nominated partner’ in the business. Additional evidence if the business is a franchise Franchise agreement signed by both or all parties 7.g. written notification or printout of online confirmation) 5. Additional evidence if the business is a limited company Proof that the company is/was registered with Companies House (e. or registered with a professional or statutory scheme to be trading legally. a copy or printout of the partnership tax return (SA800) and confirmation that it has been received by HMRC (e. café. a copy of the company annual return (AR01). certificate of incorporation – certified copy is acceptable) Proof that the company is/was registered with HMRC as an employer for PAYE and national insurance purposes Company tax returns (CT600) (copies or printouts) for the relevant period and evidence of receipt by HMRC (letter or online acknowledgement) Appointment report from Companies House (company director only) If the company has been trading for one year or more.Version 04/15 Page 122 of 127 . Certified copies are acceptable. takeaway or other food or catering business General Medical Council (GMC) reference number if you are/were or your sponsor is/was a doctor Other (please state): EEA(PR) . Some examples are given below. you must be qualified. together with proof that it has been received by Companies House (letter or printout of online acknowledgment) 6. licensed.

if the business is new) Evidence of relevant professional qualifications or accreditation (other than mandatory qualifications or accreditation listed above) Annex B . other than those listed above.g. please list these below: Now go to section 19 (declarations). or lease/contract for use of premises Evidence of shareholding Proof of employer’s liability insurance. EEA(PR) . indemnity insurance. or public liability insurance Business plan (e. Miscellaneous evidence (optional) Articles of association (limited company only) Deed of partnership/partnership agreement (partnership only) Proof of ownership of business premises.Other relevant evidence not listed above How many? If you wish to provide any other documents or evidence.8. which you feel support your application.Version 04/15 Page 123 of 127 .

and understand that this information will only be shared in limited circumstances relating to identity and security in line with section 22 of the Gender Recognition Act. as named on the back of each photograph. I confirm that if. I am aware they will otherwise be treated in confidence and that my rights under the Equality Act 2010. these details may in certain circumstances be shared with other Home Office colleagues. where necessary. I understand that documents provided in support of this application will be checked for authenticity. if relevant) should complete subsection B. I understand that the Home Office may also use the information provided by me for training purposes. or to obtain. Further details explaining when information may be passed to or from fraud prevention agencies and how that information may be used can be obtained from the Home Office website. and that. or my sponsor has. I understand that all information provided by me to the Home Office will be treated in confidence but that it may be disclosed to other government departments. unless they are unable to do so. Signed Date EEA(PR) . Data Protection Act 1998 and Article 8 of the European Convention on Human Rights will be unaffected. and that false documents will be retained and may result in my application being refused and in my prosecution and subsequent removal from the UK. and that I have had the opportunity to see the Home Office photograph guidance. I also understand that such agencies may provide the Home Office with information about me. Applicant’s declaration Please read the declaration below and sign it. there is a material change in my circumstances or new information relevant to this application becomes available. A. or seek to obtain a document certifying permanent residence or permanent residence card by means which include deception. it may be used in reaching a decision on my application or on whether I have.Declarations You (the applicant) should complete subsection A and your sponsor (named in section 4 of this form. local authorities. I understand that my details may in certain circumstances be passed to fraud prevention agencies to prevent and detect fraud and money laundering. a right of residence. before this application is decided. if such bodies provide the Home Office with any information about me which may be relevant for immigration purposes. If you are under 18. I am aware that it is an offence to make a statement or representation which I know to be false or do not believe to be true. The information I have given in this form is complete and is true to the best of my knowledge. agencies.Version 04/15 D D M M Y Y Y Y Page 124 of 127 . foreign governments and other bodies for immigration purposes or to enable them to perform their functions. I understand that if I am informing the Home Office that I have changed my gender. It should be signed by you (the applicant) and not by a representative or other person acting on your behalf. I confirm that the photographs submitted with this form are a true likeness of me. I consent to this. your parent or guardian may sign it. the police.Section 19 . I will inform the Home Office. I hereby apply for a document certifying permanent residence / permanent residence card.

and that I have had the opportunity to see the Home Office photograph guidance. I confirm that if. I am aware that it is an offence to make a statement or representation which I know to be false or do not believe to be true. there is a material change in my circumstances or new information relevant to this application becomes available. I also understand that such agencies may provide the Home Office with information about me. as named on the back of the photograph. I will inform the Home Office. the police. foreign governments and other bodies for immigration purposes or to enable them to perform their functions. their parent or guardian may sign it.Version 04/15 Page 125 of 127 . unless the sponsor is unable to sign it for one of the reasons given below. relative or partner of the applicant named in section 1. a right of residence. It should be signed by your sponsor and not by a representative or other person acting on your or your sponsor’s behalf. and that false documents will be retained and may result in the application being refused and in my /the applicant’s prosecution and subsequent removal from the UK. before this application is decided. If your sponsor is under 18.B. The information the applicant has given in this form is complete and is true to the best of my knowledge. if such bodies provide the Home Office with any information about me which may be relevant for immigration purposes. Sponsor’s declaration The sponsor named in section 4 of this application form (if applicable) should read the declaration below and sign it. or to obtain. Further details explaining when information may be passed to or from fraud prevention agencies and how that information may be used can be obtained from the Home Office website. I understand that all information provided by me or the applicant to the Home Office will be treated in confidence but that it may be disclosed to other government departments. or the applicant has. I confirm that the photograph submitted with this form is a true likeness of me. or seek to obtain a document certifying permanent residence or permanent residence card by means which include deception. I understand that my details may in certain circumstances be passed to fraud prevention agencies to prevent and detect fraud and money laundering. I understand that documents provided in support of this application will be checked for authenticity. Sponsor is unable to sign because: They have died They have left the UK I am unable to contact the sponsor Other (please state): I confirm that I am the sponsor named in section 4 of this application form and I am the family member. EEA(PR) . it may be used in reaching a decision on the application or on whether I have. agencies. and that. local authorities. I understand that the Home Office may also use the information provided by me or the applicant for training purposes.

Version 04/15 D D M M Y Y Y Y Page 126 of 127 . and understand that this information will only be shared in limited circumstances relating to identity and security in line with section 22 of the Gender Recognition Act. Signed Date EEA(PR) . where necessary. I consent to this. I am aware they will otherwise be treated in confidence and that my rights under the Equality Act 2010. Data Protection Act 1998 and Article 8 of the European Convention on Human Rights will be unaffected. these details may in certain circumstances be shared with other Home Office colleagues.I understand that if I am informing the Home Office that I have changed my gender.

EEA(PR) .Identity document checklist Please complete the table below to help us check that we have received your identity documents and to keep a record of them while they are with us.Version 04/15 Page 127 of 127 . Documents How many? Passports National identity cards Biometric residence permits (BRPs) Birth certificates Marriage/civil partnership certificates Driving licence (paper or photo) Deed poll Please make sure you send your application to the correct address as shown on the front of this form. Sending it to any other address will delay your application.