CA8454 - HM Revenue & Customs

1 Worker’s details continued
17
Do you spend time in more than one country?
23
In which countries do you carry out your work?
Yes
No
If Yes, please give a brief description of the time spent
in each country for example, five days working in the
UK, weekends spent not working in France.
24
Do you regularly carry out work in two or more EEA
Member States ? this includes any kind of work carried
out from your home in your country of residence but
not if it is less than 5% of your overall activities, such as
the occasional use of IT for work purposes, for example
18
Are you
internet, e mail, fax or phone
employed?
self-employed?
Give the full name and
address of your employer in
the box below.
Give the full name and address
of your place of business in
the box below.
Yes No
If Yes, give a brief description of your working pattern
including what proportion of work you undertake in
your country of residence, for example, two days a
week working in France, three days working in the UK
25
How long do you expect your current employment
to last?
19
When did your employment or self-employment start?
DD MM YYYY
26
If you are employed as flight crew or cabin crew
performing air passenger or freight services, what is
your nominated home base? Home base is defined in
20
What is your job title?
Annex III to Council Regulations (EEC) No 3922/91 as the
location nominated by the operator from where the crew
member normally starts and ends a duty period.
21
Are you a director of the company?
Yes
No
If Yes, give a brief description of your duties
27
From what date would you like health care cover
to start? DD MM YYYY
22
In what country are you currently paying social
security contributions?
28
Are you resident in the UK and only need health care
cover for a dependant resident in another
EEA Member State?
Yes go to Part 3
No go to Part 2
CA8454 Page 3