Form EEA4 - UK Border Agency - the Home Office

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Form EEA4: Guidance Notes1. Who Can Apply On This FormNon-EEA family members of EEA or Swiss nationals exercising Treaty rights in the UK can apply fora permanent residence card on this form. You may include your family members in the application ifthey are also non-EEA nationals.See part 12 of these notes for information about Treaty rights.Although Switzerland is not a member state of the EEA the agreement between the European Community,its member states and the Swiss Confederation on the free movement of persons givessimilar rights of residence to Swiss nationals and their family members. Any further reference on thisform to EEA nationals includes Swiss nationals.You and any family members included in the application must be in the UK to apply.2. Relevant UK LegislationThe relevant legislation for applications on this form is the Immigration (European Economic Area)Regulations 2006 (as amended). You can find these Regulations on the following website: www.legislation.gov.uk.To acquire the right to reside permanently in the UK, you need to have resided here in accordancewith the EU laws relating to free movement rights that were in force for a continuous period of 5years.3. When To ApplyYou may apply at any time after residing here for a continuous period of 5 years in accordance withthe EU laws relating to free movement rights that were in force during the 5-year period.4. Ensuring Your Application Is CompleteYour application could be delayed or even refused if it is incomplete. To avoid that, please ensurethat you do the following:• apply on the current version of form EEA4• provide photographs of yourself and any family members applying with you in the format specifiedin the separate Home Office guidance• provide all relevant documents specified in the form• complete every section of the form as required.We reserve the right to decide your application on the basis of the information and documentsprovided. It is important, therefore, to provide an explanation if you cannot give us all relevantinformation or documents when making your application.Depending on the facts of each case and where appropriate, The Home Office may make an unannouncedhome visit. Equally, the Home Office may prosecute the appropriate party if evidence of deceptionis discovered related to this application.5. Completing The FormPlease use a black pen to complete the form, and write names addresses and similar details incapital letters.In the applicant’s details and other sections where you give personal details and addresses, leave anempty box between each name and each part of the address.EEA4 Permanent Residence Card Version 06/2014 - page 6 of 38

Please note that we always use the personal details in an applicant’s passport or identity card forofficial purposes, including any permanent residence card issued if the application is successful.Take care to complete all sections as required. You must enclose a letter of explanation if you areunable to complete any part of the form because you do not have the required information.6. PhotographsYou must provide the following photographs:• Two identical passport-size colour photographs of yourself with your full name written on theback of each one.• Two identical passport-size colour photographs of any family members applying with you withtheir full name written on the back of each one.The photographs you provide must be in the format specified in the separate photograph guidance,which can be found at the following link: https://www.gov.uk/photos-for-passports.Please ensure that you place the photographs in a small sealed envelope attached to section 1 ofthe form as instructed there – and without any staples, clips, pins or anything else which could markthe photographs.The photograph(s) provided will be reproduced in your and your family members’ permanentresidence card(s) if the application(s) is/are successful.7. DocumentsIdentity and travel documents provided with the application must be originals and copies will not beaccepted.Copies of other types of document of any kind are not acceptable unless there are valid reasons fornot being able to provide the original document. In such circumstances, we may accept a copy certifiedby the body or authority which issue the original (for example, a copy of a savings book certifiedby the building society or bank) or by a notary.The reason for not being able to provide the original document must be explained in a covering letter.We are unlikely to be able to grant your application without the original document where there is novalid reason.Any documents which are not in English must be accompanied by a reliable English translation.Make sure passports are signed.8. Applying By Post – The AddressThe address to which you must post an application on form EEA4 is:Home Office - EEA Applications EEA4PO Box 590DurhamDH99 1ADPosting to any other address will delay it.Please also use this address for any other correspondence about your application.If you use Recorded or Special Delivery, this will help us to record the receipt of your application.Please make sure that you keep the Recorded or Special Delivery number.PLEASE NOTE: If you require your valuable documents to be returned to you by secure post youEEA4 Permanent Residence Card Version 06/2014 - page 7 of 38

should enclose a pre-paid self-addressed Royal Mail Special Delivery or Recorded Signed For Deliveryenvelope with your application. The pre-paid self-addressed envelope should be sufficient toaccommodate the size and weight of your documents and be insured to the appropriate level for thevalue of your documents. If this is not enclosed your documents will be returned to you using RoyalMail 2nd class post. Please consult Royal Mail’s website at www.royalmail.com for further information.9. Decision Times• For information on the current processing times for applications for a permanent residence cardon form EEA4, see the ‘Service standards’ page on the UK Visas and Immigration website:www.gov.uk/government/organisations/uk-visas-and-immigration/about/about-our-services.10. Contacting Us After You Have AppliedIf you need to contact us after you have applied, please do so as instructed below.To send us more information about your application, write to the address in part 8 and give thefollowing details in your letter:• The applicant’s full name, date of birth and nationality• Any Recorded or Special Delivery number• The date on which the application was posted or made in person• The Home Office reference number if you have one.We generally advise that you should not make any travel plans until we have returned yourpassport. If you need your passport because you have to travel urgently and unexpectedly, use thereturn of documents request form at https://www.gov.uk/visa-documents-returned.11. Obtaining Another FormYou can obtain all the EEA application forms via the UK Visas and Immigration website:www.gov.uk/visas-immigration12. Your Right To Reside In The UKEEA nationals have a right to reside in the UK for longer than 3 months if they are exercising aTreaty right in one of the following ways:• Worker• Self-employed• Student• Economically self-sufficient (including retired people)• Jobseeker• IncapacitatedEEA4 Permanent Residence Card Version 06/2014 - page 8 of 38

The following nationals may exercise Treaty rights in the UK:Austria Iceland Belgium Irish Republic Romania**Bulgaria** Italy Cyprus* Latvia*** Slovakia***Croatia**** Liechtenstein Denmark Lithuania*** Slovenia***Czech Republic*** Luxembourg Finland Malta SpainEstonia*** Netherlands Germany Norway SwedenFranceGreecePoland*** Hungary*** Portugal Switzerland (but see part 1of these notes)* A document issued by the Turkish Republic of Northern Cyprus does not establish that theperson is an EEA national. Only a document issued by the Republic of Cyprus stating that theholder is a national of the Republic of Cyprus establishes that the person is an EEA nationaland accordingly entitled to free movement within the European Union (EU).** Bulgaria and Romania joined the EU on 1 January 2007. Nationals of Bulgaria and Romaniawho wished to work in the UK before 1 January 2014 were required to hold an accessionworker authorisation document, unless exempt.If you are applying for a permanent residence card and your continuous 5-year period ofresidence in the UK in accordance with the regulations includes a period when your EEAnational family member was required to hold a valid accession worker authorisation document,you must provide evidence of this as stated in section 11. If you do not, you will not be issuedwith a permanent residence card.*** From 1 May 2004 until 30 April 2011 nationals of Czech Republic, Estonia, Hungary,Latvia, Lithuania, Poland, Slovakia and Slovenia (known as A8 countries) who wished toexercise their Treaty rights in the UK as a worker were required to register their employmentunder the Worker Registration Scheme (WRS) for a period of 12 months unless they wereexempt.If you are applying for a permanent residence card and your continuous 5-year period of residencein the UK in accordance with the regulations includes a period when your EEA nationalfamily member was required to be registered on WRS then you must provide evidence of thisas stated in section 11. If you cannot show that they were registered as required then you willnot be issued a permanent residence card.Alien passports are issued to persons of Russian origin who moved to the Baltic States,Estonia, Latvia and Lithuania, when they were part of the former Soviet Union. They are notregarded as being citizens and therefore the Estonian, Lithuanian, and Latvian authoritiesissue them with alien passports.Although they look very similar, alien passports are not proof of EEA nationality.**** Croatia joined the EU on 1 July 2013. Guidance and application forms for Croatian nationalscan be found at: https://www.gov.uk/croatian-national.13. Other EEA FormsThe other EEA forms are:EEA1 for registration certificate applications by EEA nationals and their EEA national familymembers.EEA4 Permanent Residence Card Version 06/2014 - page 9 of 38

EEA2 for residence card applications by non-EEA national family members of EEA nationals.EEA for permanent residence applications by EEA nationals and their EEA national family members.DRF1 for derivative residence card applications by people who do not have a right to resideunder the Free Movement Directive but have a derivative right of residence in the UK. For furtherinformation, see https://www.gov.uk/derivative-right-residence14. Choosing An Immigration AdviserIf you use the services of an immigration adviser, take care when choosing one. The Office of theImmigration Services Commissioner (OISC) regulates immigration advisers.Their website at www.oisc.gov.uk contains a list of authorised advisers. It also has links to websitesfor solicitors, barristers and legal executives.If you have a complaint about an immigration adviser or need other information, the OISC contactdetails are:Office of the Immigration Services Commissioner5th FloorCounting House53 Tooley StreetLondonSE1 2QNTelephone: 0845 000 0046Alternatively the Solicitors Regulation Authority, which regulates solicitors in England and Wales, canhelp you find a solicitor if you contact them on 0870 606 2555 or visit their website at www.sra.org.uk.The address and telephone number for any complaints about a solicitor are:Legal Complaints ServiceVictoria Court8 Dormier PlaceLeamington SpaWarwickshireCV32 5AETelephone: 0845 608 656515. Complaints About Our ServiceIf you wish to make a complaint about our service, please refer to the complaints page on our websitefor detailed information about how to do so.16. Data Protection NoticeWe will treat all information provided by you in confidence but may disclose it to other governmentdepartments, agencies, local authorities, the police, foreign governments and other bodies forimmigration purposes or to enable them to carry out their functions.We may also use the information provided by you for training purposes.EEA4 Permanent Residence Card Version 06/2014 - page 10 of 38

1.9 Place of birth - town or city and country1.10 Passport or travel document number 1.11 Home Office reference (ifapplicable)1.12 Your UK address -please inform us if this changesPostcode1.13 Your daytime telephone number 1.14 Your mobile telephone number if youhave one1.15 Your email address if you have one. We may use your email address tocommunicate with you about the status of your application. Please write your emailaddress clearly in block capitals and note that we can only send updates to the emailaddress you provide1.16 Please re-enter your email address in block capitals in the box below1.17 Name and address in the UK for all correspondence about your application ifdifferent from 1.12Postcode1.18 if you have completed 1.17 and the address is that of your immigration adviser,please state their Office of the Immigration Services (OISC number)EEA4 Permanent Residence Card Version 06/2014 - page 12 of 38

Section 2 - Family Members Included In Your ApplicationPlease give details below of any non-EEA national family members included in the application.If more than 3 family members are applying, please give their details on a photocopy of thispage, enclose it with the form, and place the photographs in the envelope attached to section1 as instructed there. Non-EEA national family members wishing to apply for a residence cardshould complete form EEA2.If the family member is your child, please provide documentary evidence of the relationship(e.g. full birth certificate), if your details are not shown in the child’s passport or ID card.If the family member is a relative other than a child (e.g. parent, brother, sister, cousin), pleaseprovide appropriate documentary evidence to confirm the relationship (e.g. full birth, marriageor civil partnership certificates).PhotographsYou must provide two identical photographs of each family member who is applying.Write the family member’s full name on the back of each photograph and enclose bothphotographs in the envelope attached to section 1 as instructed there.2.1 Family member’s full name2.2 Nationality2.3 Date of birth2.4 Gender -please tickD D M M Y Y Y Y Male2.5 Relationship to you- please specify2.6 Home Office reference (if applicable)Female2.7 Family member’s full name2.8 Nationality2.10 Gender -2.9 Date of birthplease tickD D M M Y Y Y Y Male2.12 Home Office reference (if applicable)Female2.11 Relationship toyou - please specifyEEA4 Permanent Residence Card Version 06/2014 - page 13 of 38

2.13 Family member’s full name2.14 Nationality2.16 Gender -2.15 Date of birthplease tickD D M M Y Y Y Y Male2.18 Home Office reference (if applicable)Female2.17 Relationship toyou - please specifySection 3 – Your EEA National Family MemberPlease give the personal details of your EEA national family member below.If you are applying under the judgment in the case of Surinder Singh (see section 6), pleasegive your British citizen family member’s details in this section.Note 1. There is no requirement for your EEA national family member to apply for a documentcertifying permanent residence and we can decide your case without them applying. However,we must receive evidence of their identity, e.g. passport or identity card. If your EEA nationalfamily member wishes to apply for a document certifying permanent residence, they may applyseparately using form EEA3.3.1 Their title – please tickMr Mrs Miss Ms Other3.2 If other, what is their title?3.3 Their full name as in their passport or ID card3.4 Surname or family name as in their passport or ID card3.5 Any other name(s) by which they are or have been known3.6 NationalityEEA4 Permanent Residence Card Version 06/2014 - page 14 of 38

3.7 Do they also hold British citizenship? Yes No3.8 Their date of birth 3.9 Their gender – please tickD D M M Y Y Y Y male female3.10 Home Office reference ifthey have one3.11 Passport, ID card orregistration certificate number3.12 Their UK address – please inform us if this changesPostcode3.13 Their daytime telephone number 3.14 Their mobile telephone number if they have one3.15 Their relationship to youNote 2. If you are applying for a permanent residence card and during the 5-year continuousresidence period your EEA national family member has died or left the UK, please complete section4.If you are applying for a permanent residence card because your EEA national family memberwho was exercising Treaty rights as a worker or self-employed person has died but you have beenresident in the UK for less than 5 years, please complete section 5.If you are applying for a permanent residence card on the basis that your British citizen familymember is treated as an EEA national under the judgment in the case of Surinder Singh, pleasecomplete section 6. Please go straight to section 7 for all other applications.EEA4 Permanent Residence Card Version 06/2014 - page 15 of 38

Section 4 – Retained Right Of Residence In The UKYou must complete this section if you are applying for a permanent residence card because ofa divorce, or because your EEA national family member has died or left the UK. You must alsocomplete section 5, 6 or 7 (whichever is applicable) to show how your EEA family member wasexercising Treaty rights, and section 8 to detail any absences from the UK.4.1 Reason for having a retained right of residence in the UK. Please tick relevant box:Divorce/ annulment/dissolution of civilpartnership. (Answer 4.2 to4.7)EEA national family memberhas died. (Answer 4.8 to4.12)EEA national has left the UK.(Answer 4.13 to 4.16)4.2 Date of marriage: 4.3 Date the divorce/annulment/dissolution ofcivil partnership was finalised:D D M M Y Y Y Y D D M M Y Y Y Y4.4 Have you been married for at least 3 years and lived inthe UK for at least one of the three years?4.5 Do you have custody of your EEA national familymember’s child?4.6 Do you have a right of access to your EEA nationalfamily member’s child where the access must take place inthe UK?YesYesYesNoNoNoIf you have answered yes to 4.5 or 4.6 please give the child’s/children’s name(s) and date(s) of birthin the box below if they have not been included in section 2.4.7 Were you or a family member a victim of domesticviolence or other difficult circumstances during the marriageor civil partnership?YesNoEEA4 Permanent Residence Card Version 06/2014 - page 16 of 38

Please give details in the box below of which educational establishment they are attending. Youmust also provide evidence of this such as a letter from the school or college. Then go to section 7.4.17 Are you, or are you the family member of, someone who is either (please tick):A worker?Economically self-sufficient?Self-employed?Temporarily unable to work through illness or accident?Involuntarily unemployed?Unemployed and undertaking vocational training?4.18 If you answered yes to 4.17 please give details below. The information and evidence youshould provide is the same as in section 7 for details of the exercise of Treaty rights. Please alsostate the name, date of birth and nationality of your family member (if applicable). Continue on aseparate sheet if necessary and enclose it with this form.EEA4 Permanent Residence Card Version 06/2014 - page 18 of 38

Section 5 – Permanent Residence Due To Death Of EEA National Family MemberYou must complete this section if you are applying for a permanent residence card because yourEEA national family member who was working or self-employed has died but you have beenresident in the UK for less than 5 years. You must also complete section 7 to show how your EEAnational family member was exercising Treaty rights.5.1 Date your EEA national family member died D D M M Y Y Y Y5.2 Were you living with your EEA national family memberimmediately before they died?5.3 Had your EEA national family member lived in the UKfor at least the 2 years immediately before they died?5.4 Was your EEA national family member’s death due to anaccident at work or an occupational disease?YesYesYesNoNoNoEEA4 Permanent Residence Card Version 06/2014 - page 19 of 38

SECTION 6 – Permanent Residence in Surinder Singh CasesComplete this section if you are applying for a permanent residence card under the judgmentin the case of Surinder Singh because your British citizen family member has exercised theirTreaty rights as a worker or self-employed person in an EEA Member State other than the UK.Previous documentation6.1 Have you, or any family members included in this application, previously been issued witha residence card under the Surinder Singh judgment as the family member of the British citizennamed in section 3, or did you/your family members enter the UK with an EEA family permitissued as the family member of that British citizen?Yes go to section 8.Nofor any non-EEA family member who has not been issued with a residence cardor EEA family permit on this basis, answer all questions in this section.About the British citizen6.2 Has your British citizen family member exercised their Treaty rights as a worker or selfemployedperson in an EEA Member State (other than the UK)?Yes - as a workerYes - as a self-employed personNo – you will not qualifyin this category6.3 What is the EEA Member State (other than the UK) in which your British citizen familymember exercised their Treaty rights as a worker or self-employed person?6.4 Date on which your British citizen family member began their employment or selfemploymentin the EEA Member State named above:day month year6.5 Date on which your British citizen family member ceased their employment or selfemploymentin the EEA Member State named above:day month yearEEA4 Permanent Residence Card Version 06/2014 - page 20 of 38

About you6.6 How are you related to the British citizen?Spouse/civil partnerChild or grandchild aged under 21Dependent child or grandchild aged over 21Dependent parent or grandparentOther – please specifyNote 1. You must provide evidence of how you and any family members included in thisapplication are related to the British citizen, such as marriage/civil partnership certificates,birth certificates, etc, and evidence of dependency in the case of children over 21 and parents/grandparents.Note 2: If you are the spouse or civil partner of the British citizen, answer questions 6.7 to 6.21below.If you are not the spouse or civil partner of the British citizen, answer questions 6.9 to 6.21below.If you are the spouse or civil partner of the British citizen:6.7 Date you married or registered the civil partnership:day month year6.8 Did you live with the British citizen while theywere exercising Treaty rights in the EEA MemberState named above?YesNoEEA4 Permanent Residence Card Version 06/2014 - page 21 of 38

Residence in the EEA state6.9 Please give details of where you, the British citizen, and your family lived while the Britishcitizen was working or self-employed in the EEA state named above. Start with the most recentaddress. Continue on a separate sheet if necessary.Please also provide relevant evidence, such as tenancy agreements, leases, mortgagestatements, etc. If the accommodation was provided by an employer, friend or relative, pleaseprovide a letter from them confirming this, together with proof that you/the British citizen lived atthat address (e.g. utility bills in your/their name).AddressWho lived there (you,the British citizen, anyother family members)Dates livedthere (from/to)Ownership of property (pleasetick for each address)Owned by you/the BritishcitizenRented by you/the BritishcitizenProvided by employer/friend/relativeOther - please specifyOwned by you/the BritishcitizenRented by you/the BritishcitizenProvided by employer/friend/relativeOther - please specifyOwned by you/the BritishcitizenEEA4 Permanent Residence Card Version 06/2014 - page 22 of 38

Rented by you/the BritishcitizenProvided by employer/friend/relativeOther - please specify6.10 Details of any absences by you or the British citizen from the EEA Member State while you/they were resident there. Continue on a separate sheet if necessary.Who was absent from the EEAstate (you, the British citizen,or any other family membersincluded in the application)Country or countriesvisitedDate ofdeparturefrom theEEA stateDate ofreturn tothe EEAstateNumber ofdays6.11 Date on which the British citizen returned to live in the UK:day month year6.12 If you or any of your family members lived with the British citizen in the EEA state, pleaseconfirm the date you/they returned to live in the UK. If not applicable, write ‘N/A’.You:day month yearOther family members:EEA4 Permanent Residence Card Version 06/2014 - page 23 of 38

Evidence of integration into the EEA Member State6.13 Use the box below to provide any other information which you feel demonstrates thatthe British citizen transferred the centre of their life to the EEA Member State, and providesupporting evidence where possible. This could include things like:• details of financial commitments in the EEA state (for example, mortgage, rental agreement,bank account, investments)• evidence of speaking the language of the EEA state• if you had any children or grandchildren living with you in the EEA state, details of any nursery/school/college/universitythey attended• membership of any social groups or sports clubs, etc.• details of any community activities undertaken in the EEA stateEvidence of your British citizen family member’s employment or self-employmentin the EEA stateIf your British citizen family member was a worker in the EEA state mentioned above, pleasecomplete questions 6.14 to 6.17 with details of their employment and then go to section 8.If your British citizen family member was self-employed in the EEA state mentioned above,please complete questions 6.18 to 6.21 with details of their self-employment and then go tosection 8.WorkerPlease provide details of how your British citizen family member exercised Treaty rights as aworker in the EEA Member State mentioned above.6.14 Full name of employer (i.e. business or firm)6.15 Address of the business where your British citizen family member was employedPostcodeEEA4 Permanent Residence Card Version 06/2014 - page 24 of 38

Section 7 – Details Of The Exercise Of Treaty Rights For 5 YearsTo qualify for permanent residence, your EEA national family member must normally have exercisedTreaty rights in the UK for a continuous period of five years through employment, self-employment,study or economic self-sufficiency (including retirement). If your EEA national family memberstopped working or being self-employed due to early retirement, reaching state pension age orpermanent incapacity, or if you have retained the right of residence following divorce from the EEAnational or following their death or departure from the UK (see sections 4 and 5) then you are onlyrequired to provide evidence of the EEA national exercising Treaty rights before that point.The details given in this section must be supported by the documentary evidence in section 11.If your EEA national family member has already acquired permanent residence, please provideeither their document certifying permanent residence (if they have one) or evidence of how theyacquired permanent residence, for example evidence of exercising Treaty rights for a continuousperiod of 5 years prior to the date at which they acquired permanent residence.If your EEA national family member has a document certifying permanentresidence, please tick this box and go to section 8, otherwise please completesection 7 below.From (dd/mm/yyyy)EmploymentTo (dd/mm/yyyy)Self-EmploymentSeeking workEconomic self-sufficiency (includingretirement)StudyPermanent incapacityTemporarily incapacitatedUnemployed and undertakingvocational training7.2 If your EEA national family member did not exercise Treaty rights for some or all of this periodbut were supported by the employment or funds of a family member, or if there are any otherperiods of time not accounted for in the above table, please give details below. Continue on aseparate sheet if necessary and enclose it with this formEEA4 Permanent Residence Card Version 06/2014 - page 26 of 38

7.3 If your EEA national family member exercised Treaty rights in employment, self-employmentor study, please give details below starting with the most recent if there is more than one employerand/or place of study. Continue on a separate sheet if necessary and enclose it with this form.Name and address of employer or place ofstudyFromddmmyyyyUntilddmmyyyyType of business if selfemployedEEA4 Permanent Residence Card Version 06/2014 - page 27 of 38

Section 8 – Time Spent Outside The UKTo qualify for permanent residence you need to have resided in the UK continuously for 5 yearsunless you are applying on the grounds that your EEA national family member stopped working orbeing self-employed due to early retirement, reaching state pension age or permanent incapacity,or has died.. Time spent outside the UK which does not exceed 6 months in total in any year andabsences due to special circumstances will not affect your period of residence.8.1 Please give the date and place of your first arrival in the UK for yourself, your EEA nationalfamily member and any family members mentioned in section 2. Continue on a separate sheet ifnecessary and enclose it with this form.NameDate of first arrivaldd/mm/yyyyPlace of first arrival8.2 Please complete the table below for yourself, your EEA national family member and anyfamily members mentioned in section 2 to show any time you have spent outside the UK duringthe 5 years continuous residence. If your EEA national family member has a document certifyingpermanent residence you only need to mention any absences they have had of more than 2consecutive years since they received the document. When counting the number of days absent donot include the day of departure or the day of return. Continue on a separate sheet if necessary andenclose it with this formName of person(s) absent fromthe UKCountry or countriesvisitedDate ofdeparturefrom UKDate ofreturn toUKNumber ofdays8.3 If any of the absences mentioned above exceed 6 months in any year please explain below thereasons why you were absent from the UK. Continue on a separate sheet if necessary and encloseit with this form.EEA4 Permanent Residence Card Version 06/2014 - page 28 of 38

Section 9 - Personal History (criminal convictions, war crimes, etc.)You must provide details as requested below of any criminal convictions you may have both in theUK and overseas. Please note that it is an offence under Section 26(1)(c) of the Immigration Act1971 to make a statement or representation which you know to be false or do not believe to be true.Information given will be checked with other agencies.9.1. Have you or any family members who are applying with you been convicted of any criminaloffence in the UK or any other country?Yes - go to question 9.2 No - go to question 9.39.2. Please give details below for each criminal conviction, starting with the most recent one. If youor any family members who are applying with you have received more than two convictions, pleasephotocopy this page and enclose it with this form.Note: We will carry out criminal record checks on all applicants and family members. You must givedetails of all unspent and spent criminal convictions. This includes road traffic offences but not fixedpenalty notices (such as speeding or parking tickets) unless they were part of a sentence of the court.This includes all drink-driving offences.Criminal conviction 1Country where convictedNature of the offenceSentence givenDate sentenced D D M M Y Y Y YIf you or any family members who are applying with you weresentenced to a period of imprisonment, what was the length of theprison sentence imposed (in months)?Criminal conviction 2Country where convictedmonthsNature of the offenceSentence givenEEA4 Permanent Residence Card Version 06/2014 - page 29 of 38

Date sentenced D D M M Y Y Y YIf you or any family members who are applying with you were sentencedto a period of imprisonment, what was the length of the prison sentenceimposed (in months)?months9.3. Do you or any family members who are applyingwith you have any civil judgments against you or any civilpenalty under the UK Immigration Acts?Yes - go to 9.4No - go to 9.59.4. Give details for each civil judgment or any civil penalty under UK the Immigration Acts, startingwith the most recent one.If you or any family members who are applying with you have received more than two civil judgmentsand/or civil penalties under the UK Immigration Acts, please photocopy this page and enclose it withthis form.Details of judgment or civil penalty 1Date of judgment or civil penalty D D M M Y Y Y YCountry where judgment madeDetails of judgment or civil penalty 2Date of judgment or civil penalty D D M M Y Y Y YCountry where judgment madeYou must answer questions 9.5 to 9.10 below even if you have answered no to question 9.1.For help in answering these questions, please see the definitions at the end of this section.9.5. Have you or any family members who are applying with you everbeen charged in any country with a criminal offence for which youhave not yet been tried in court?9.6. In times of either peace or war have you or any family memberswho are applying with you ever been involved, or suspected ofinvolvement, in war crimes, crimes against humanity or genocide?9.7. Have you or any family members who are applying with you everbeen involved in, supported or encouraged terrorist activities in anycountry?9.8. Have you or any family members who are applying with you everbeen a member of, or given support to, an organisation which hasbeen concerned in terrorism?YesYesYesYesNoNoNoNoEEA4 Permanent Residence Card Version 06/2014 - page 30 of 38

9.9. Have you or any family members who are applying with youever, by any means or medium, expressed views that justify or glorifyterrorist violence or that may encourage others to terrorist acts orother serious criminal acts?9.10. Have you or any family members who are applying with you everengaged in any other activities which might indicate that you may notbe considered to be persons of good character?YesYesNoNo9.11. How long have you lived in the UK? Years MonthsPlease provide details of any periods of absence of more than 6 months during that time.Date you left the UK(ddmmyyyy)Date you returned tothe UK (ddmmyyyy)Reason for absence9.12. 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 yearsYou should tell us about any family, friends, or other connections with that country.CountrySocial cultural or family ties9.13. If you have answered yes to question 9.5, 9.6, 9.7, 9.8, 9.9 or 9.10, you must give further detailsin the space provided below. If you need more space, continue on a separate sheet and enclose itwith this form.EEA4 Permanent Residence Card Version 06/2014 - page 31 of 38

Section 10 – PhotographsYou must provide the relevant photographs specified below. They must be in the format specifiedin the separate Home Office photograph guidance. If they are not, they may be rejected asunacceptable and you will have to provide others which are acceptable. This will delay considerationof your application.Tick the relevant box(es) to confirm the photographs you are providing and enclose them in a smallsealed envelope attached to section 1 as instructed there.Two recent identical colour passport-size photographs of yourself with your namewritten on the back of each one. Please see the guidance notes for information onwhat types of photograph are acceptable.Two recent identical colour passport-size photographs of each family member includedin section 2 and applying for an extension of stay in the UK with you, with their namewritten on the back of each one.Section 11 DocumentsFor your application to be complete, you must provide the documents specified below which arerelevant to your application. If you do not, we reserve the right to decide your application on thebasis of the information and documents provided. Tick the relevant box(es) to show the documentsyou are providing.The documents must be originals. Any which are not in English must be accompanied by a reliableEnglish translation.Please note that in some cases, we may have to ask for other documentation in addition to thosespecified in this form.Your current passport. If you last entered the UK on a previous passport or ID card,please also provide this document if you have it. If you do not have a passport, youmust provide another form of identity and explain why you are unable to provide avalid passport.The current passport(s) of each family member included in section 2 for whom apermanent residence card is required. If they do not have a passport, you mustprovide another form of identity and explain why they are unable to provide a validpassport.Your EEA national family member’s current passport or ID Card. If they do not have apassport or ID card, you must provide another form of identity and explain why theyare unable to provide a valid passport or ID card.EEA4 Permanent Residence Card Version 06/2014 - page 32 of 38

If Section 4 (Retained Rights) has been completed: evidence as applicable such asDecree Absolute, Decree of Annulment, Certificate of Dissolution. Proof of residencein UK such as tenancy agreements, bank statements, utility bills. Your EEA nationalfamily member’s death certificate or proof they have left the UK. Proof of a child orgrandchild attending an educational course. Proof of custody or access rights such asa court order. Proof that you or a family member are either working, self employed oreconomically self-sufficient as below. Proof of domestic violence such as injunctions,court convictions or police cautions.If section 6 (Surinder Singh cases) has been completed and you have not previouslybeen issued with residence documentation on this basis: evidence that youand your British citizen family member resided in another EEA member state at a timewhen they were a worker or self-employed person in that member state, such astenancy agreements, bank statements, utility bills. Evidence that you and your Britishcitizen family member have resided continuously in the UK following your return fromthe EEA state in which your UK family member was a worker or self-employed person.See section 6 for further guidance on the information and evidence you must submit.For time spent in employment: this can include contracts of employment, letter(s) fromyour EEA national family member’s employer(s) confirming your employment, P60s,or wage slips should be provided. These should feature a full National InsuranceNumber rather than a temporary one. If your EEA national family member wasrequired to be registered on the Worker Registration Scheme or to hold an accessionworker authorisation document at any time during your 5-years continuous residenceyou must provide all of their worker registration cards and certificates or their workerauthorisation document(s) (for example, their accession worker card), and proof oftheir employment with each employer named on the certificate and cards.For time spent in self-employment: this can include evidence to show your EEAnational family member is self-employed, e.g. a lease on business premises, HMRevenue & Customs (HMRC) self-assessment forms, business bank statements,accountants letter, invoices or receipts or National Insurance contributions.For time spent as a student: evidence of a school, college or university letterconfirming your EEA national family member’s enrolment on a course of study,evidence of comprehensive sickness insurance (see section below on comprehensivesickness insurance). Evidence of funds available to your EEA national family membersuch as bank statements, documents confirming the receipt of a grant or scholarship,or declaration of sufficient funds.For time spent as economically self-sufficient: this must include evidence ofcomprehensive sickness insurance for your EEA national family member and anyfamily members included in your application (see section below on comprehensivesickness insurance) and of funds to show your EEA national family member iseconomically self-sufficient, e.g. a bank statement. If these funds come from anotherfamily member, evidence of their employment or funds should be supplied. Evidenceto show your EEA national family member is retired, e.g. document(s) confirming thereceipt of a pension.EEA4 Permanent Residence Card Version 06/2014 - page 33 of 38

For time spent seeking work: this can include evidence of your EEA national familymember’s unemployment such as letters from their last employer. Evidence that theyhave registered as unemployed with Jobcentre Plus (or the Social Security Officeor Jobs and Benefits Office if living in Northern Ireland). Evidence of them seekingwork e.g. copies of application forms or letters of rejection or invite to interview frompotential employers, evidence of registration with a recruitment agency. Evidence ofvocational or academic qualifications.If your EEA national family member has stopped working or being self-employed dueto permanent incapacity: this can include evidence to show they are permanentlyincapacitated, e.g. a consultant’s letter or medical report confirming permanentincapacity along with proof of having previously been in employment or selfemployment.You must also provide proof of them either residing in the UK for the 2years immediately before they stopped work or being self-employed, or proof that theirincapacity is as a result of an accident at work or occupational disease that entitlesthem to a pension paid in full or part by an institution in the UK.If your EEA national family member has stopped working or being self-employed dueto early retirement or reaching state pension age: this can include proof that they haveresided in the UK for at least the 3 years immediately before they retired and that theywere working or self-employed for at least 12 months immediately before they retired.For any period when your EEA family member was unable to work or be self-employeddue to temporary incapacity: medical report or letter from a doctor confirming the illness oraccident and how long they were, or are expected to be, unable to work or engage in selfemployment.Evidence that they were working or self-employed immediately before thetemporary incapacity.If your EEA national family member has the right of permanent residence: your EEAnational family member’s document certifying permanent residence.As evidence of comprehensive sickness insurance (this requirement only applies topersons exercising Treaty rights as students or self-sufficient persons):You must provide either a private comprehensive sickness insurance policy documentthat covered for medical treatment in the majority of circumstances, or a validEuropean Health Insurance Card (EHIC) that covered the 5-year period of residence inthe UK.As evidence of residence in the UK by you and your family members both currentlyand continuously over 5 years:Proof of residence: this can include tenancy agreements, utility bills and bankstatements. For children this could include letters from their school.EEA4 Permanent Residence Card Version 06/2014 - page 34 of 38

If your EEA national family member has a Document certifying permanent residence:proof that they have not been absent from the UK for more than 2 consecutiveyears since they gained the right of permanent residence. This can include tenancyagreements, utility bills and bank statementsAs evidence of relationships:For family relationships: marriage certificates, civil partnership certificates or birthcertificates.For unmarried partners: proof that you continue to be in a durable relationship. Suchas joint bank or building society statements, joint tenancy agreements, council tax billsor evidence that you have both continued to pay utility bills at the property at whichyou reside. You should also include your residence card confirming that your rightof residence as an unmarried partner has previously been recognised by the HomeOffice.As evidence of dependency on your EEA national family member:For children and grandchildren over 21 and direct relatives in the ascending line: Evidencethat the EEA national family member has sufficient funds to maintain you, and that youare, in practice, reliant on these funds to meet your needs such as for example, bankstatements and evidence of money transfers. This evidence should cover the 5-yearperiod.For more distant relatives such as cousins, nephews and nieces: Evidence that yourEEA national family member was maintaining you before your admission to the UK andcontinues to do so. For example, bank statements and evidence of money transfers. Orthat you were a member of the EEA national family household in the country from whichthey have come, and that you continue to be a member of the same household in the UK.For example, joint bank or building society statements, joint tenancy agreements, counciltax bills or other evidence that you share and have shared the same address. You shouldalso include your residence card confirming that your right of residence as an extendedfamily member has previously been recognised by the Home Office.EEA4 Permanent Residence Card Version 06/2014 - page 35 of 38

Section 12 – DeclarationPlease read the declaration below and sign it. It should be signed by you (the applicant) and not bya representative or other person acting on your behalf. If you are under 18, your parent or guardianshould sign it.I hereby apply for a permanent residence card for myself and any non-EEA national family memberslisted in this form. The information I have given in this form is complete and is true to the best of myknowledge.I confirm that the photographs submitted with this form are a true likeness of myself and any familymembers applying with me, as named on the back of each photograph, and that I have had theopportunity to see the Home Office photograph guidance.I confirm that if, before this application is decided, there is a material change in my circumstances ornew information relevant to this application becomes available, I will inform the Home Office.I understand that all information provided by me to the Home Office will be treated in confidence butthat it may be disclosed to other government departments, agencies, local authorities, the police,foreign governments and other bodies for immigration purposes or to enable them to perform theirfunctions, and that, if such bodies provide the Home Office with any information about me whichmay be relevant for immigration purposes, it may be used in reaching a decision on my application.I understand that my details may in certain circumstances be passed to fraud prevention agenciesto prevent and detect fraud and money laundering. I also understand that such agencies mayprovide the Home Office with information about me. Further details explaining when informationmay be passed to or from fraud prevention agencies and how that information may be used can beobtained from the Home Office website.I understand that documents provided in support of this application will be checked for authenticity,and that false documents will be retained and may result in my application being refused and in myprosecution and subsequent removal from the UK.I understand that the Home Office may also use the information provided by me for trainingpurposes.I am aware that it is an offence to make a statement or representation which I know to be false or donot believe to be true, or to obtain, or seek to obtain a permanent residence card by means whichinclude deception.I understand that if I am informing the Home Office that I have changed my gender, these detailsmay in certain circumstances be shared with other Home Office colleagues. I consent to this, wherenecessary and understand that this information will only be shared in limited circumstances relatingto identity and security in line with Section 22 of the Gender Recognition Act. I am aware they willotherwise be treated in confidence and that my rights under the Equality Act 2010, Data ProtectionAct 1998 and Article 8 of the European Convention on Human Rights will be unaffected.Signed:Date:D D M M Y Y Y YEEA4 Permanent Residence Card Version 06/2014 - page 36 of 38

Photographs And Documents ChecklistPlease complete this part of the form to help us check that we have received your photographs anddocuments and to keep a record of them while they are with us. At ‘A’ tell us how many of each ofthe listed items you are providing with your application. At ‘B’ list any other documents provided byyou and state how many in each case. Continue on a separate sheet if necessary and enclose itwith this form. All documents must be originals.A. Listed items Howmany?Photographs of yourselfB. Other documents Howmany?Photographs of any family membersPassports (including for your EEAnational family member)ID cards (including for your EEAnational family member)BRP cardsContracts of employment/employersletter/wage slipsA lease/HM Revenue and Customs(HMRC) form/NI contributions/Accountant’s letterBank statements/invoices/receiptsSchool/college/university letterComprehensive sickness insurancedocument/EHICPension documentConsultant’s letter/medical reportProof of divorce/annulment/dissolution.EEA national family member’s deathcertificate/ proof they have left the UKProof that a child or grandchild isattending an educational courseProof of custody or access rightsUtility bills/tenancy agreementsProof of domestic violenceBirth certificatesMarriage/Civil Partnership certificateEEA4 Permanent Residence Card Version 06/2014 - page 37 of 38

Final ChecklistTo ensure that your application is complete, please make the following checks before posting it. Tickeach box that is relevant to your application.Is EEA4 the right form for youand is it valid for use? See dateon front pageHave you completed all relevantsections of the form as specified?Have you paid the specified fee? Seepayment guidance notes.Have you sent the documents and photographs specified in section 10 and 11 as listed above?Current passport(s) or IDcards(s) including those for familymembersWorker registration card and allworker registration certificate(s)PhotographsAll other relevant documentsspecified in section 11Have you, or your parent/guardian if you are under 18,signed and dated the declarationin section 12?If you are unable to send us anyof the documents specified insection 11 which are relevant toyour application have you givenan explanation and said whenyou will be able to send them?Have you paid the specified fee?See payment guidance notes.Finally, please make sure that the application is addressed as shown below:Home Office – EEA ApplicationsPO Box 590DurhamDH99 1ADEEA4 Permanent Residence Card Version 06/2014 - page 38 of 38