application for permanent eea4 · 2016-10-05 · residence application for permanent residence in...

VVeerrssiioonn 0055//22000088

TThhiiss ffoorrmm iissttoo bbee uusseedd ffoorr aapppplliiccaattiioonnssmmaaddee oonn oorr aafftteerr2266 MMaayy 22000088

EEEEAA44 VVeerrssiioonn 0055//22000088 -- ppaaggee 11 ooff 1133

EEEEAA44PPEERRMMAANNEENNTTRREESSIIDDEENNCCEE

AAPPPPLL II CCAATT II OONN FFOORR PPEERRMMAANNEENNTT AAPPPPLL II CCAATT II OONN FFOORR PPEERRMMAANNEENNTT RREESS II DDEENNCCEE II NN TTHHEE UUKK RREESS II DDEENNCCEE II NN TTHHEE UUKK

BBYYBBYYNNOONN -- EEUURROOPPEEAANN EECCOONNOOMMII CC AARREEAA NNOONN -- EEUURROOPPEEAANN EECCOONNOOMMII CC AARREEAA

(( NNOONN -- EEEEAA )) NNAATT II OONNAALL FFAAMMII LLYY MMEEMMBBEERRSS((NNOONN -- EE EEAA )) NNAATT II OONNAALL FFAAMM II LLYY MMEEMMBBEERRSSOOFF EE EEAA NNAATT II OONNAALLSS RREESS II DD II NNGG II NN TTHHEE UUKKOOFF EEEEAA NNAATT II OONNAALLSS RREESS II DD II NNGG II NN TTHHEE UUKK

OORR BBYYOORR BBYYNNOONN -- SSWW II SSSS OORR NNOONN -- EEEEAA NNAATT II OONNAALL NNOONN -- SSWWII SSSS OORR NNOONN -- EE EEAA NNAATT II OONNAALL

FFAAMM II LLYY MMEEMMBBEERRSS OOFF SSWWII SSSS NNAATT II OONNAALLSS FFAAMMII LLYY MMEEMMBBEERRSS OOFF SSWWII SSSS NNAATT II OONNAALLSS RREESS II DD II NNGG II NN TTHHEE UUKKRREESS II DD II NNGG II NN TTHHEE UUKK

WWOORRKKIINNGG TTOOGGEETTHHEERR TTOO PPRROOTTEECCTT TTHHEE PPUUBBLLIICC

PPlleeaassee rreeaadd tthhee gguuiiddaannccee nnootteess aatt tthhee ffrroonntt ooff tthhiiss ffoorrmm bbeeffoorree mmaakkiinnggyyoouurr aapppplliiccaattiioonn..

OOuurr aapppplliiccaattiioonn ffoorrmmss cchhaannggee ppeerriiooddiiccaallllyy.. IIff yyoouu oobbttaaiinn tthhiiss ffoorrmm ssoommeettiimmee bbeeffoorree aappppllyyiinngg,, pplleeaassee cchheecckk tthhaatt iitt iiss ssttiillll tthhee vveerrssiioonn wwhhiicchh mmuussttbbee uusseedd wwhheenn yyoouu aarree rreeaaddyy ttoo aappppllyy..

TThheerree iiss nnoo ffeeee ffoorr aann aapppplliiccaattiioonn oonn tthhiiss ffoorrmm..

FFoorr iinnffoorrmmaattiioonn aabboouutt ootthheerr EEEEAA ffoorrmmss,, sseeee ppaaggee 44..

IIff yyoouu nneeeedd hheellpp iinn ccoommpplleettiinngg tthhiiss ffoorrmm tteelleepphhoonnee 00884455 001100 55220000..

AApppplliiccaattiioonnss oonn tthhiiss ffoorrmm mmaayy oonnllyy bbee mmaaddee bbyy ppoosstt..

IIff yyoouu aappppllyy bbyy ppoosstt yyoouu mmuusstt sseenndd yyoouurr aapppplliiccaattiioonn ttoo tthhee ffoolllloowwiinngg aadd--ddrreessss::

UUKK BBoorrddeerr AAggeennccyyEEuurrooppeeaann AApppplliiccaattiioonnss EEEEAA44PPOO BBooxx 330066DDeepptt 4455LLiivveerrppoooollLL22 00QQNN

FFOORRMM EEEEAA44:: GGUUIIDDAANNCCEE NNOOTTEESS

11 FFOORR WWHHIICCHH AAPPPPLLIICCAATTIIOONNSS SSHHOOUULLDD YYOOUU UUSSEE FFOORRMMEEEEAA44??

TToo aappppllyy ffoorr aa ppeerrmmaanneenntt rreessiiddeennccee ccaarrdd aass aa nnoonn--EEEEAA nnaa--ttiioonnaall ffaammiillyy mmeemmbbeerr ooff aann EEEEAA nnaattiioonnaall eexxeerrcciissiinngg TTrreeaattyyrriigghhttss iinn tthhee UUKK.. See part 14 of these notes for informationabout Treaty rights.

You may include your family members in the application ifthey are also non-EEA nationals. A non-EEA national is a na-tional of a country which is not part of the European Eco-nomic Area.

TToo aappppllyy ffoorr aa ppeerrmmaanneenntt rreessiiddeennccee ccaarrdd aass aa nnoonn--SSwwiissss oorrnnoonn--EEEEAA nnaattiioonnaall ffaammiillyy mmeemmbbeerr ooff aa SSwwiissss nnaattiioonnaall rreessiidd--iinngg iinn tthhee UUKK.. You may include your family members in theapplication if they are also non-Swiss or non-EEA nationals.

Although Switzerland is not a Member State of the EEA theAgreement between the European Community, its MemberStates and the Swiss Confederation on the free movementof persons gives similar rights of residence to family mem-bers of Swiss nationals who are not themselves either Swissor EEA nationals.

You and any family members included in the applicationmust be in the UK to apply.

22 RREELLEEVVAANNTT UUKK LLEEGGIISSLLAATTIIOONN

The relevant legislation for applications on this form is TheImmigration (European Economic Area) Regulations 2006.You can consult it on our website atwwwwww..uukkbbaa..hhoommeeooffffiiccee..ggoovv..uukk or obtain a copy from HMSO.

To acquire the right to reside permanently in the UK, youneed to have resided here with your EEA or Swiss nationalfamily member for a continuous period of 5 years in accor-dance with the relevant EEA Regulations.

33 WWHHOO CCAANN AAPPPPLLYY OONN TTHHIISS FFOORRMM??

Only non-EEA or non-Swiss family members of EEA or Swissnationals residing in the UK.

44 WWHHEENN TTOO AAPPPPLLYY

You may apply at any time during your lawful stay in the UK.If you apply when you are here unlawfully, that will be takeninto consideration in deciding your application.

55 MMAAKKIINNGG SSUURREE YYOOUURR AAPPPPLLIICCAATTIIOONN IISS CCOOMMPPLLEETTEE

Your application will be delayed if it is incomplete. To avoidthat, you must:

mmaakkee iitt oonn tthhee ccuurrrreenntt vveerrssiioonn ooff EEEEAA44

pprroovviiddee aallll tthhee pphhoottooggrraapphhss ooff yyoouurrsseellff aanndd aannyy ffaammiillyy mmeemmbbeerrss iinncclluuddeedd iinn tthhee aapppplliiccaattiioonn aass ssppeecciiffiieedd iinn tthhee ffoorrmm

pprroovviiddee aallll ddooccuummeennttss ssppeecciiffiieedd iinn tthhee ffoorrmm

ccoommpplleettee aallll sseeccttiioonnss ooff tthhee ffoorrmm aass rreeqquuiirreedd

ssiiggnn aanndd ddaattee tthhee ddeeccllaarraattiioonn iinn tthhee ffoorrmm..

66 CCOOMMPPLLEETTIINNGG TTHHEE FFOORRMM

Please note the following guidance and information when youcomplete the form.

UUssee aa bbllaacckk ppeenn to complete the form - and capital letters fornames, addresses and similar details.

CCoommpplleettee aallll sseeccttiioonnss as required, including the Personal His-tory section.

SSeeccttiioonn 11 This is where you give your own details. Leave aspace between each name and part of the address(es) re-quired in this section (do the same where names and ad-dresses are required in other sections).

SSeeccttiioonnss 11 aanndd 22 It’s essential that you provide the photo-graphs of yourself and your family members included in theapplication. Please use one staple or one paper clip in eachperson’s case to attach the photographs within the spacesprovided. Do not use glue or any other sticky adhesive. Seepart 7 below for more guidance on photographs.

If there is any difference between the personal details givenin these sections and those contained in your and/or yourfamily member(s) passports or identity cards, we will alwaysuse those given in the passport(s) or identity card(s).

AAllll sseeccttiioonnss If you are at present unable to provide any ofthe information or details requested in any of the relevantsections, please explain the reasons in a letter and encloseit with the application form. If you need help with any of thequestions, you can seek advice by telephoning 00884455 00110055220000.

SSeeccttiioonn 66 This section lists the documents and photographswhich you have to provide. If you can’t provide any of thedocuments specified in the application form, please explainwhy in a letter with the form and say when you will be ableto provide them. See part 8 below for more guidance on doc-uments.

Ensure that passport or identity card and those of any familymembers included in the application are signed as required.

SSeeccttiioonn 77 You must sign and date the declaration. If youdon’t, it will delay your application.

77 PPHHOOTTOOGGRRAAPPHHSS

You must provide the following photographs:

TTwwoo iiddeennttiiccaall ccoolloouurr ppaassssppoorrtt--ssiizzee pphhoottooggrraapphhss ooff yyoouurrsseellff wwiitthh yyoouurr nnaammee wwrriitttteenn oonn tthhee bbaacckk ooff eeaacchh oonnee..

TTwwoo iiddeennttiiccaall ccoolloouurr ppaassssppoorrtt--ssiizzee pphhoottooggrraapphhss ooff aannyy ffaamm--iillyy mmeemmbbeerrss iinncclluuddeedd iinn tthhee aapppplliiccaattiioonn wwiitthh tthheeiirr nnaammeess wwrriitttteenn oonn tthhee bbaacckk ooff eeaacchh oonnee..


FFOORRMM EEEEAA44:: GGUUIIDDAANNCCEE NNOOTTEESS

The photographs should be in colour, recent (within the lastmonth), and approximately 45 millimetres high and 35milimetres wide, the size of a passport photo.

Each photograph must show the individual’s full face clearlyagainst a light background. Sunglasses are not acceptable. Noris any head covering unless this has to be worn for religious orcultural reasons. But if the covering conceals the face, this willnot be acceptable.

Use one staple or paper clip in each person’s case to attachthem to the spaces provided. When stapling, do so at the edgeof the photograph so as not to damage the image of the face. DDoonnoott uussee gglluuee oorr aannyy ootthheerr ssttiicckkyy aaddhheessiivvee..

If the application(s) is/are successful, the photograph(s) pro-vided will be reproduced in your and your family members’permanent residence card(s).

88 DDOOCCUUMMEENNTTSS

TThhee ddooccuummeennttss pprroovviiddeedd wwiitthh tthhee aapppplliiccaattiioonn mmuusstt bbee oorriiggiinnaallss..

Copies of any kind are not acceptable unless there are valid rea-sons for not being able to provide the original document. In suchcircumstances, we may accept a copy certified by the body orauthority which issued the original (for example, a copy of a sav-ings book certified by the building society or bank), or by a no-tary.

The reasons for not being able to provide the original documentmust be explained in a covering letter. As a rule, we are unlikelyto be able to grant your application without the original docu-ment.

Any documents which are not in English must be accompaniedby a reliable English translation.

99 AAPPPPLLYYIINNGG BBYY PPOOSSTT -- TTHHEE AADDDDRREESSSS

The address to which you must post an application on formEEA4 is:


Posting it to any other address will delay it.

Please also use this address for any other correspondenceabout your application. Applications on this form have to bemade by post. TThheeyy ccaannnnoott bbee mmaaddee iinn ppeerrssoonn aatt aannyy ooff oouurrppuubblliicc eennqquuiirryy ooffffiicceess aass wwee ddoo nnoott ooffffeerr tthhiiss sseerrvviiccee ffoorr aapp--pplliiccaattiioonnss mmaaddee oonn ffoorrmm EEEEAA44..

If you use Recorded or Special Delivery, this will help us torecord the receipt of your application. Please make surethat you keep the Recorded or Special Delivery number.

We will return your passport(s) and other documents byRecorded Delivery. If you would like them to be returned bySpecial Delivery, you must provide a prepaid Special Deliv-ery envelope which is large enough.

1100 DDEECCIISSIIOONN TTIIMMEESS

We aim to decide applications as soon as possible. For infor-mation on the current processing times for permanent resi-dence on form EEA4, see the “EEA/EU nationals” page on ourwebsite.

1111 CCOONNTTAACCTTIINNGG UUSS AAFFTTEERR YYOOUU HHAAVVEE AAPPPPLLIIEEDD

If you need to contact us after you have applied, please doso as instructed below.

TToo sseenndd uuss mmoorree iinnffoorrmmaattiioonn aabboouutt yyoouurr aapppplliiccaattiioonn, write tothe address in part 9 and give the following details in a let-ter:

the applicant’s full name, date of birth and nationality

any Recorded or Special Delivery number

the date on which the application was posted

the Home Office reference number if you have one.

IIff yyoouu nneeeedd yyoouurr ppaassssppoorrtt bbeeccaauussee yyoouu hhaavvee ttoo ttrraavveell uurr--ggeennttllyy aanndd uunneexxppeecctteeddllyy, please call 00884455 001100 55220000 andprovide the personal and other details listed immediatelyabove.

1122 OOBBTTAAIINNIINNGG AANNOOTTHHEERR FFOORRMM

You can obtain application forms via the UKBA website atwwwwww..uukkbbaa..hhoommeeooffffiiccee..ggoovv..uukk

1133 OOTTHHEERR TTEELLEEPPHHOONNEE EENNQQUUIIRRIIEESS

For enquiries other than obtaining an application form call00884455 001100 55220000..

1144 YYOOUURR RRIIGGHHTT TTOO RREESSIIDDEE IINN TTHHEE UUKK

The non-EEA national family members of an EEA nationalhave a right to reside in the UK if their EEA national familymember is exercising a Treaty right in one of the followingcategories:

• WWoorrkkeerr:: a person who is pursuing an effective and gen-uine activity for remuneration as an employed person;

•SSeellff--eemmppllooyyeedd •SSttuuddeenntt•EEccoonnoommiiccaallllyy sseellff--ssuuffffiicciieenntt•RReettiirreedd:: a person who has been economically active; or•IInnccaappaacciittaatteedd:: a person who is permanently incapacitated and unable to pursue employment, having been economi-cally active.

The following nationals may exercise Treaty Rights in theUnited Kingdom:

Austria BelgiumBulgaria** Cyprus*Czech Republic DenmarkEstonia Finland


FFOORRMM EEEEAA44:: GGUUIIDDAANNCCEE NNOOTTEESSFrance GermanyGreece HungaryIceland Irish RepublicItaly Latvia Liechtenstein LithuaniaLuxembourg MaltaNetherlands NorwayPoland PortugalRomania** SlovakiaSlovenia SpainSweden Switzerland (but see part 1 of these notes)

*A document issued by the Turkish Republic of NorthernCyprus does not establish that the person is an EEA na-tional. Only a document issued by the Republic of Cyprusstating that the holder is a national of the Republic ofCyprus establishes that the person is a EEA national and ac-cordingly entitled to free movement within the EU.

**The nationals of Bulgaria and Romania joined the Euro-pean Union on 1 January 2007. Guidance and applicationforms for Bulgarian and Romanian nationals are to be foundat wwwwww..wwoorrkkiinnggiinntthheeuukk..ggoovv..uukk

1155 OOTTHHEERR EEEEAA FFOORRMMSS

The other EEA forms are as follows:

EEEEAA 11 for registration certificate applications by EEA na-tional and their EEA national or Swiss national family mem-bers and by Swiss national and their Swiss or EEA nationalfamily members

EEEEAA 22 for residence card applications by non-EEA national ornon-Swiss national family members of an EEA national orSwiss national

EEEEAA 33 for permanent residence applications by EEA nationaland their EEA or Swiss national family members and bySwiss nationals and their Swiss or EEA national family mem-bers

FFMMRRSS for residence stamp applications by non-EEA nationalfamily members of persons required to register under theWorker Registration Scheme.

1166 CCHHOOOOSSIINNGG AANN IIMMMMIIGGRRAATTIIOONN AADDVVIISSEERR

If you engage an immigration adviser, you should take carewhen choosing one. The Office of the Immigration ServicesCommissioner (OISC) regulates immigration advisers. Theirwebsite at wwwwww..ooiisscc..ggoovv..uukk contains a list of authorised ad-visers. It also has links to websites for solicitors, barristersand legal executives.If you have a complaint about an immigration adviser orneed other information, the OISC contact details are:

OOffffiiccee ooff tthhee IImmmmiiggrraattiioonn SSeerrvviicceess CCoommmmiissssiioonneerr55tthh FFlloooorr CCoouunnttiinngg HHoouussee5533 TToooolleeyy SSttrreeeettLLoonnddoonn SSEE11 22QQNN

Telephone: 00884455 000000 00004466

Alternatively the Solicitors Regulation Authority, which regu-lates solicitors in England and Wales, can help you find a so-licitor if you contact them on 00887700 660066 22555555 or visit theirwebsite at wwwwww..ssrraa..oorrgg..uukk

The address and telephone number for any complaints abouta solicitor are:

LLeeggaall CCoommppllaaiinnttss SSeerrvviicceeVViiccttoorriiaa CCoouurrtt88 DDoorrmmeerr PPllaacceeLLeeaammiinnggttoonn SSppaaWWaarrwwiicckksshhiirreeCCVV3322 55AAEE

Telephone: 00884455 660088 66556655

1177 CCOOMMPPLLAAIINNTTSS AABBOOUUTT OOUURR SSEERRVVIICCEE

If you wish to make a complaint about our service, pleaserefer to the complaints page on our website for detailed infor-mation about how to do so.

If you are unable to access the website or if you need furtheradvice after reading the information on the complaints page,please telephone our contact centre on 00884455 001100 55220000.

1188 DDAATTAA PPRROOTTEECCTTIIOONN NNOOTTIICCEE

We will treat all information provided by you in confidencebut may disclose it to other government departments, agen-cies, local authorities, the police, foreign governments andother bodies for immigration purposes or to enable them toperform their functions.

We may also use the information provided by you for train-ing purposes.


Your full name as in your passport or identity card (ID card)

Surname or family name

Passport or identity card number Home Office reference if you have one

11..33

11..44

11..66

Any other name(s) by which you are or have been known

11..77

National insurance number if you have one

11..88

11..99

11..1111

Nationality

Your UK address - please inform us immediately if this changes

Your daytime telephone number

11..1155

Your e-mail address if you have one

Your mobile telephone number if you have one

Post code

SSEECCTT IIOONN 11 -- AAPPPPLL II CCAANNTT ’’ SS DDEE TTAA II LLSS

11..1144

If you have completed 11..1144 and the address is that of your immigration adviser, please state their Office of the ImmigrationServices Commissioner (OISC) number

11..1122

11..55

11..1133

Your title - please tick

Your date of birth

If ootthheerr, what is your title?

OtherMsMissMrs11..11

11..22Day Month Year

Mr

Your gender - please tick Male Female

Post code

Date you lastentered the UK

Day Month Year

EEEEAA44PPEERRMMAANNEENNTTRREESSIIDDEENNCCEE

11..1100


Name and address in the UK for all correspondence about your application if different from 11..1111

SSttaappllee hheerree

Attach two identicalphotographs of you

(the applicant)here with staple or

paper clip

DDoo nnoott uussee gglluuee oorrootthheerr ssttiicckkyy aaddhheessiivvee

IIff tthhee ffaammiillyy mmeemmbbeerr iiss yyoouurr cchhiilldd,, pplleeaassee pprroovviiddee ddooccuummeennttaarryy eevviiddeennccee ooff tthhee rreellaattiioonnsshhiipp ((iiee ffuullll bbiirrtthh cceerrttiiffiiccaattee)),, iiff yyoouurr ddeettaaiillssaarree nnoott sshhoowwnn iinn tthhee cchhiilldd’’ss ppaassssppoorrtt oorr IIDD ccaarrdd..

IIff tthhee ffaammiillyy mmeemmbbeerr iiss aa rreellaattiivvee ootthheerr tthhaann aa cchhiilldd ((eegg ppaarreenntt,, bbrrootthheerr,, ssiisstteerr,, ccoouussiinn)),, pplleeaassee pprroovviiddee aapppprroopprriiaattee ddooccuummeennttaarryy eevviiddeennccee ttoo ccoonnffiirrmm tthhee rreellaattiioonnsshhiipp ((iiee ffuullll bbiirrtthh,, mmaarrrriiaaggee oorr cciivviill ppaarrttnneerrsshhiipp cceerrttiiffiiccaatteess))..

PPlleeaassee ggiivvee ddeettaaiillss bbeellooww ooff aannyy nnoonn--EEEEAA oorr nnoonn--SSwwiissss nnaattiioonnaall ffaammiillyy mmeemmbbeerrss iinncclluuddeedd iinn tthhee aapppplliiccaattiioonn.. IIff mmoorree tthhaann 33 aarree aappppllyyiinngg,, pplleeaassee ggiivvee tthheeiirr ddeettaaiillss,, wwiitthh pphhoottooggrraapphhss,, oonn aa ccooppyy ooff tthhiiss ppaaggee aanndd eenncclloossee iitt wwiitthh tthhiiss ffoorrmm..

SSEECCTT IIOONN 22 -- NNOONN -- EEEEAA OORR NNOONN -- SSWWIISSSS NNAATT IIOONNAALL FFAAMM II LLYY MMEEMMBBEERRSS II NNCCLLUUDDEEDD IINN YYOOUURR AAPPPPLL II CCAATT II OONN


Family member’s full name

Nationality

Date of birth Gender -please tick

Day Male Female Year Month

Home Office reference if they have one


Nationality




Nationality



Relationship to you


Relationship to you


Relationship to you


Attach two identicalphotographs of your

family memberhere with staple or

paper clip





paper clip





paper clip


PPlleeaassee ggiivvee tthhee ppeerrssoonnaall ddeettaaiillss ooff yyoouurr EEEEAA oorr SSwwiissss nnaattiioonnaall ffaammiillyy mmeemmbbeerr bbeellooww..

SSEECCTT IIOONN 33 -- YYOOUURR EE EEAA OORR SSWWII SSSS FFAAMMII LLYY MMEEMMBBEERR (( SSPPOONNSSOORR ))

Their telephone number

Any other name(s) by which they are or have been known

Evidence of relationship: birth certificate/marriage certificate/civil partnership certificate ((pplleeaassee cciirrccllee ttoo iinnddiiccaattee))

Date they last entered the UK

Their full name as in their passport or identity card (ID card)

Surname or family name

33..22

33..33

33..55 Nationality

33..44

Their title - please tick OtherMsMissMrs33..11 Mr

Their date of birth 33..66Day Month Year

Their gender - please tick Male Female

Home Office reference if they have one 33..88 Passport, ID card or registration certificate number33..77

33..99 Their UK address - please inform us immediately if this changes

Post code

Their relationship to you 33 .. 1111

33 .. 1122

Day Month Year 33 .. 1133

33..1100

If ootthheerr, what is your title?

Mobile number if theyhave one

Daytime number

NNoottee 11.. TThheerree iiss nnoo rreeqquuiirreemmeenntt ffoorr yyoouurr EEEEAA oorr SSwwiissss ffaammiillyy mmeemmbbeerr ttoo aappppllyy ffoorr ppeerrmmaanneenntt rreessiiddeennccee aanndd wwee ccaann ddeecciiddee yyoouurrccaassee wwiitthhoouutt hhiimm oorr hheerr aappppllyyiinngg.. HHoowweevveerr,, wwee mmuusstt rreecceeiivvee eevviiddeennccee ooff hhiiss//hheerr iiddeennttiittyy,, eegg ppaassssppoorrtt oorr iiddeennttiittyy ccaarrdd.. IIff yyoouurr EEEEAAoorr SSwwiissss ffaammiillyy mmeemmbbeerr wwiisshheess ttoo aappppllyy ffoorr ppeerrmmaanneenntt rreessiiddeennccee,, hhee oorr sshhee mmaayy aappppllyy sseeppaarraatteellyy,, uussiinngg ffoorrmm EEEEAA33..


SSEECCTT IIOONN 44 -- DDEETTAA II LL SS OOFF TTHHEE EEXX EERRCC II SS EE OOFF TTRREEAATT YY RR IIGGHHTTSS FFOORR 55 YYEEAARRSSBBYY YYOOUURR EE EEAA OORR SSWWII SSSS NNAATT II OONNAALL FFAAMMII LLYY MMEEMMBBEERR

TToo qquuaalliiffyy ffoorr ppeerrmmaanneenntt rreessiiddeennccee,, yyoouu wwiillll nneeeedd ttoo hhaavvee bbeeeenn aa ffaammiillyy mmeemmbbeerr ffoorr aa ccoonnttiinnuuoouuss ppeerriioodd ooff 55 yyeeaarrss ooff aannEEEEAA oorr SSwwiissss nnaattiioonnaall wwhhoo hhaass eexxeerrcciisseedd aa TTrreeaattyy rriigghhtt iinn tthhee UUKK tthhrroouugghh eemmppllooyymmeenntt,, sseellff-- eemmppllooyymmeenntt,, ssttuuddyy,, eeccoonnoommiiccsseellff ssuuffffiicciieennccyy,, rreettiirreemmeenntt oorr ppeerrmmaanneenntt iinnccaappaacciittyy.. TThhee ddeettaaiillss ggiivveenn iinn tthhiiss sseeccttiioonn wwiillll hhaavvee ttoo bbee ssuuppppoorrtteedd bbyy tthhee ddoocc--uummeennttaarryy eevviiddeennccee ssppeecciiffiieedd iinn sseeccttiioonn 66..

Please tick one or more of the boxes below to show the way(s) in which your EEA or Swiss national family member hasexercised Treaty rights for the past 5 years and give the relevant dates.

If your EEA or Swiss national family member exercised Treaty rights in employment, self-employment or study, pleasegive details below, starting with the most recent if more than one employer and/or place of study. Continue on a sepa-rate sheet if you need more space, and enclose it with this form.

From Until

Name and address of employer or place of study From Until

Type of business if

self-employedJob title if employed

Employment

Self employment

Study

Retired

Permanent incapacity

Economic self-sufficiency

44 .. 11

44 .. 22


55 .. 11 Do you or any family members included in this application have any criminal convictions in theUK or any other country (including traffic offences) or any civil judgments made against you?

YYeess NNoo

SS EECCTT IIOONN 55 -- PPEERRSSOONNAALL HH II SS TTOORRYY YYoouu mmuusstt aannsswweerr aallll tthhee qquueessttiioonnss iinn tthhiiss sseeccttiioonn oonn bbeehhaallff ooff yyoouurrsseellff aanndd aannyy ffaammiillyy mmeemmbbeerrss iinncclluuddeedd iinn tthhiiss aapppplliiccaattiioonn..IItt iiss aann ooffffeennccee uunnddeerr SSeeccttiioonn 2266((11))((cc)) ooff tthhee IImmmmiiggrraattiioonn AAcctt 11997711 ttoo mmaakkee aa ssttaatteemmeenntt oorr rreepprreesseennttaattiioonn wwhhiicchh yyoouu kknnoowwttoo bbee ffaallssee oorr ddoo nnoott bbeelliieevvee ttoo bbee ttrruuee.. IInnffoorrmmaattiioonn ggiivveenn wwiillll bbee cchheecckkeedd wwiitthh ootthheerr aaggeenncciieess..

If you have answered yyeess to question 55..11 above please give details below for each criminal conviction and/or civil judgment, startingwith the most recent one - but first see NNoottee 22 about criminal convictions. If you or any family members included in this applicationhave received more than two convictions and/or civil judgments, give details on a copy of this page and enclose it with this form.

Date of sentence/judgmentDetails of the sentence or civil judgment (give details on separate sheet if you need more space)

Country where the sentence was passed or the civil judgment was made

55 .. 22 Have you or any family members included in this application ever been charged in any countrywith a criminal offence for which you have not yet been tried in court?

YYeess NNoo55 .. 33 In times of either peace or war have you or any family members included in this application everbeen involved, or suspected of involvement, in war crimes, crimes against humanity or genocide?

Nature of the criminal offence or the civil action (give details on a separate sheet and enclose it with this form if you need more space)

55 .. 44

Have you or any family members included in this application ever been a member of, or givensupport to, an organisation which has been concerned in terrorism?

Have you or any family members included in this application ever, by any means or medium,expressed views that justify or glorify terrorist violence or that may encourage others to terroristacts or other serious criminal acts?

NNaammee ooff ppeerrssoonn ccoonnvviicctteedd oorr aaggaaiinnsstt wwhhoomm aa cciivviill jjuuddggmmeenntt wwaass mmaaddee

NNoottee 22 CCoonnvviiccttiioonnss ssppeenntt uunnddeerr tthhee RReehhaabbiilliittaattiioonn ooff OOffffeennddeerrss AAcctt 11997744 nneeeedd nnoott bbee ddiisscclloosseedd.. MMoorree iinnffoorrmmaattiioonn aabboouutt tthhee AAcctt iissggiivveenn ttoowwaarrddss tthhee eenndd ooff tthhiiss sseeccttiioonn..

55 .. 55 YYeess

YYeess

YYeess NNoo

NNoo

NNoo

Have you or any family members included in this application ever been involved in, supported or encouraged terrorist activities in any country?

YYeess NNoo

55 .. 66

FFoorr hheellpp iinn aannsswweerriinngg tthhee qquueessttiioonnss bbeellooww,, pplleeaassee sseeee tthhee ddeeffiinniittiioonnss oonn tthhee nneexxtt ppaaggee..

Date of sentence/judgment

Country where the sentence was passed or the civil judgment was made

NNaammee ooff ppeerrssoonn ccoonnvviicctteedd oorr aaggaaiinnsstt wwhhoomm aa cciivviill jjuuddggmmeenntt wwaass mmaaddee

Nature of the criminal offence or civil action (give details on separate sheet and enclose it with this form if you need more space)

Details of the sentence or civil judgment (give details on separate sheet if you need more space)


55 .. 77 Have you or any family members included in this application ever engaged in any other activitieswhich might indicate that you may not be considered to be persons of good character?

If you have answered yyeess to question 55..22,, 55..33,, 55..44,, 55..55,, 55..66 or 55..77 above please give further details in the space provided below. If youneed more space, continue on a separate sheet.

YYeess NNoo

DDEEFFIINNIITTIIOONNSS

For the purposes of answering questions 55..33 to 55..77,, the following information provides guidance on actions which may constitute warcrimes, crimes against humanity, genocide, or terrorist activities.

This guidance is not exhaustive. The full definitions of war crimes, crimes against humanity and genocide can be found in Schedule8 of the International Criminal Court Act 2001 at wwwwww..ooppssii..ggoovv..uukk//aaccttss//aaccttss22000011//2200001100001177..hhttmm or purchased from The StationeryOffice (telephone 00887700 660000 55552222). It is your responsibility to satisfy yourself that you are familiar with the definitions and can answerthe questions accurately on behalf of yourself and any family members included in the application.

WWaarr ccrriimmeessGrave breaches of the Geneva Conventions committed during an armed conflict. This includes an internal armed conflict and an international armed conflict. The types of acts that may constitute a war crime include wilful killing, torture, extensive destruction ofproperty not justified by military necessity, unlawful deportation, the intentional targeting of civilians and the taking of hostages.

CCrriimmeess aaggaaiinnsstt hhuummaanniittyyActs committed at any time (not just during armed conflict) as part of a widespread or systematic attack, directed against any civilianpopulation with knowledge of the attack. This would include offences such as murder, torture, rape, severe deprivation of liberty inviolation of fundamental rules of international law and enforced disappearance of persons.

GGeennoocciiddee Acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group.

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

OOrrggaanniissaattiioonnss ccoonncceerrnneedd iinn tteerrrroorriissmmAn organisation is concerned in 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.

RREEHHAABBIILLIITTAATTIIOONN OOFF OOFFFFEENNDDEERRSS AACCTT 11997744

The Rehabilitation of Offenders Act 1974 enables criminal convictions to become 'spent' or ignored after a 'rehabilitation period'. Thelength of the rehabilitation period depends on the sentence given. For a custodial (prison) sentence the rehabilitation period is decidedby the original sentence, not the time served. Prison sentences of more than two and a half years can never become spent and shouldalways be disclosed. Further information on rehabilitation periods can be found at Nacro's Resettlement Plus Helpline on 002200 7788440066446644 or by obtaining a free copy of their leaflet on 002200 77884400 66442277.

SSEECCTT IIOONN 55 -- PPEERRSSOONNAALL HH II SSTTOORRYY


SSEECCTT IIOONN 66 -- DDOOCCUUMMEENNTTSS AANNDD PPHHOOTTOOGGRRAAPPHHSS

YYoouurr EEEEAA oorr SSwwiissss ffaammiillyy mmeemmbbeerr’’ss ppaassssppoorrtt oorr IIDD ccaarrdd..

FFoorr ttiimmee ssppeenntt aass aa ssttuuddeenntt,, letter(s) from school(s)/college(s) or university(ies) confirming details of course(s), and evidenceof funds eg. bank statements or similar documentary evidence.

FFoorr ttiimmee ssppeenntt aass aann eeccoonnoommiiccaallllyy sseellff--ssuuffffiicciieenntt ppeerrssoonn, a bank statement or similar documentary evidence showingfunds available to your family member, or a document confirming your family member’s employment, and evidence of compre-hensive sickness insurance for you and your family members.

FFoorr ttiimmee ssppeenntt aass aa rreettiirreedd ppeerrssoonn, evidence of the receipt of a pension.

FFoorr ttiimmee ssppeenntt ppeerrmmaanneennttllyy iinnccaappaacciittaatteedd, a doctor’s letter or medical report confirming permanent incapacity, havingpreviously been in employment or self-employment.

AAss eevviiddeennccee ooff tthhee eexxeerrcciissee ooff TTrreeaattyy rriigghhttss iinn tthhee UUnniitteedd KKiinnggddoomm bbyy yyoouurr EEEEAA oorr SSwwiissss ffaammiillyy mmeemmbbeerr,, bbootthh ccuurr--rreennttllyy aanndd ccoonnttiinnuuoouussllyy oovveerr tthhee ppaasstt 55 yyeeaarrss,, pplleeaassee pprroovviiddee tthhee ffoolllloowwiinngg ddooccuummeennttss::

FFoorr ttiimmee ssppeenntt iinn sseellff--eemmppllooyymmeenntt an accountant’s letter, Inland Revenue self - assessment forms, invoices/receipts,payment of tax and national insurance contributions and lease on business premises or Construction Industry Scheme (CIS) card.

FFoorr ttiimmee ssppeenntt iinn eemmppllooyymmeenntt letter(s) from your family member’s employer(s) confirming employment, P60s and mostrecent wage slips.

TTwwoo rreecceenntt,, ccoolloouurr ppaassssppoorrtt--ssiizzee pphhoottooggrraapphhss ooff yyoouurrsseellff with your name written on the back of each photograph.Please see the guidance notes for information on what types of photograph are acceptable.

TThhee ccuurrrreenntt ppaassssppoorrtt((ss)) oorr IIDD ccaarrdd((ss)) ooff eeaacchh ffaammiillyy mmeemmbbeerr included in section 2 for whom permanent residenceis required. If they do not have passport(s) or ID card(s) you must provide another form of identity for them.

YYoouurr ccuurrrreenntt ppaassssppoorrtt oorr IIDD ccaarrdd.. If you do not have a passport or ID card, you must provide another form of identity.

TTwwoo rreecceenntt,, ccoolloouurr ppaassssppoorrtt--ssiizzee pphhoottooggrraapphhss ooff eeaacchh ffaammiillyy mmeemmbbeerr included in section 2 for whom permanentresidence is required with their name written on the back of each photograph.


FFoorr yyoouurr aapppplliiccaattiioonn ttoo bbee ccoommpplleettee,, yyoouu mmuusstt pprroovviiddee tthhee ddooccuummeennttss aanndd pphhoottooggrraapphhss lliisstteedd iinn tthhiiss sseeccttiioonn wwhhiicchhaarree rreelleevvaanntt ttoo yyoouurr aapppplliiccaattiioonn..

AAnnyy ddooccuummeennttss wwhhiicchh aarree nnoott iinn EEnngglliisshh mmuusstt bbee aaccccoommppaanniieedd bbyy aa rreelliiaabbllee EEnngglliisshh ttrraannssllaattiioonn..

TTiicckk tthhee bbooxxeess nneexxtt ttoo tthhee rreelleevvaanntt iitteemmss ttoo sshhooww tthhee ddooccuummeennttss aanndd pphhoottooggrraapphhss yyoouu aarree pprroovviiddiinngg.. AAttttaacchh aallllpphhoottooggrraapphhss ttoo tthhee ssppaacceess iinn sseeccttiioonnss 11 aanndd 22 aass iinnssttrruucctteedd tthheerree..

SSEECCTT II OONN 77 -- DDEECCLLAARRAATT IIOONN

I hereby apply for a permanent residence card for myself and any non-EEA or non-Swiss national family members listed in this form. The information I have given in this form is complete and is true to the best ofmy knowledge. I also declare that the photographs submitted with this form are a true likeness of myself andany family members included in the application, as named on the back of each photograph.

I confirm that if, before this application is decided, there is a material change in my circumstances or new 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 but that itmay be disclosed to other government departments, agencies, local authorities, the police, foreign govern-ments and other bodies for immigration purposes or to enable them to perform their functions; and that, ifsuch bodies provide the Home Office with any information about me which may be relevant for immigrationpurposes, it may be used in reaching a decision on my application.

I understand that documents provided in support of this application will be checked for authencity; and thatfalse documents will be retained and may result in my application being refused and in my prosecution andsubsequent removal from the United Kingdom.

I understand that the Home Office may also use the information provided by me for training purposes.

II aamm aawwaarree tthhaatt iitt iiss aann ooffffeennccee ttoo mmaakkee aa ssttaatteemmeenntt oorr rreepprreesseennttaattiioonn wwhhiicchh II kknnooww ttoo bbee ffaallssee oorr ddoo nnoott bbeelliieevvee ttoo bbee ttrruuee,, oorr ttoo oobbttaaiinn oorr sseeeekk ttoo oobbttaaiinn ppeerrmmaanneenntt rreessiiddeennccee bbyy mmeeaannss wwhhiicchh iinncclluuddee ddeecceeppttiioonn..

Date

Signed

YYoouu mmuusstt nnooww rreeaadd tthhee ddeeccllaarraattiioonn bbeellooww aanndd ssiiggnn iitt.. IItt mmuusstt bbee ssiiggnneedd bbyy yyoouu ((tthhee aapppplliiccaanntt)) aanndd nnoott bbyy aa rreepprreesseennttaattiivvee oorr ootthheerr ppeerrssoonn aaccttiinngg oonn yyoouurr bbeehhaallff.. IIff yyoouu aarree uunnddeerr 1188,, yyoouurr ppaarreenntt oorr gguuaarrddiiaann mmaayy ssiiggnn..


AAPPPPLL II CCAANNTT ’’ SS CCHHEECCKKLL II SSTT

Is EEA4 the right form for you and is it valid for use? Seedate on front page.

Have you completed all relevant sections of the form asspecified?

TToo eennssuurree tthhaatt yyoouurr aapppplliiccaattiioonn iiss ccoommpplleettee,, pplleeaassee mmaakkee tthhee ffoolllloowwiinngg cchheecckkss bbeeffoorree ppoossttiinngg iitt.. TTiicckk eeaacchh bbooxxtthhaatt iiss rreelleevvaanntt ttoo yyoouurr aapppplliiccaattiioonn..

Have you sent the documents and photographs specified in section 6 as listed below?

Current passport(s) or ID card(s)including those for family mem-ber(s) and your EEA or Swiss na-tional sponsor

Photographs

If you are unable to send us any of the documents speci-fied in section 6 which are relevant to your application,have you given an explanation and said when you will beable to send them?

Have you, or your parent/guardian if you are under 18,signed and dated the declaration in section 7?

Finally, please make sure that the application is addressed exactly as shown below.

All other relevant documents specified in section 6



PPHHOOTTOOGGRRAAPPHHSS AANNDD DDOOCCUUMMEENNTTSS CCHHEECCKKLL II SS TT

PPlleeaassee ccoommpplleettee tthhiiss ppaarrtt ooff tthhee ffoorrmm ttoo hheellpp uuss cchheecckk tthhaatt wwee hhaavvee rreecceeiivveedd yyoouurr pphhoottooggrraapphhss aanndd ddooccuummeennttss,, aanndd ttookkeeeepp aa rreeccoorrdd ooff tthheemm wwhhiillee tthheeyy aarree wwiitthh uuss.. AAtt ““AA””,, tteellll uuss hhooww mmaannyy ooff eeaacchh ooff tthhee lliisstteedd iitteemmss yyoouu aarree pprroovviiddiinngg wwiitthhyyoouurr aapppplliiccaattiioonn.. AAtt ““BB””,, lliisstt aannyy ootthheerr ddooccuummeennttss pprroovviiddeedd bbyy yyoouu aanndd ssttaattee hhooww mmaannyy iinn eeaacchh ccaassee.. CCoonnttiinnuuee oonn aa sseepp--aarraattee sshheeeett iiff nneecceessssaarryy aanndd eenncclloossee iitt wwiitthh tthhiiss ffoorrmm.. AAllll ddooccuummeennttss mmuusstt bbee oorriiggiinnaallss..

AA.. LLiisstteedd iitteemmss BB.. OOtthheerr ddooccuummeennttssHHooww mmaannyy??

HHooww mmaannyy?

Photographs of yourself

Photographs of any family members

Passports and/ID cards

Your EEA or Swiss family member’s pass-port or ID card

Employment letter/P60s/wage slips

Accountant’s letter/Inland Revenueform/invoices

School/college/university letter

Evidence of funds

Comprehensive sickness insurance docu-ment

Pension document

Doctor’s letter/medical reports

CIS card/lease

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