Eea3 Application Form PDF Details

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Question	Answer
Form Name	Eea3 Application Form
Form Length	33 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	8 min 15 sec
Other names	eea 3 form, application forms for disabled badge, eea3, eea3 form

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Application For A Document

Certifying Permanent Residence

To be used by European Economic Area (EEA) or Swiss nationals residing in the UK and their EEA or Swiss national family members.

It is not mandatory to complete this application form. However it will assist in dealing with your application more efficiently if this form is used. Please read the guidance notes at the front of this form before making your application.

Please note there is a fee of £55 for each person applying for a document certifying permanent residence. You must pay this fee even if you choose not to use this application form. For further information, see the payment guidance notes on pages 2 to 4.

Our application forms change periodically. If you obtain this form some time before applying, please check that it is still the version which must be used when you are ready to apply.

For information about other EEA forms, see page 7.

If you need help in completing this form telephone 0845 010 5200

Applications on this form must be made by post to the following address:

Home Office – EEA Applications

PO Box 590

Durham

DH99 1AD

EEA3

DOCUMENT CERTIFYING PERMANENT RESIDENCE

Version 07/2013

	This form is
	to be used for
	applications
	made on or after
WORKING TOGETHER TO PROTECT THE PUBLIC	1 July 2013

EEA3 Version 07/2013 - page 1 of 33

PAYMENT GUIDANCE

The Fee

There is a fee of £55 for this application.

For each family member applying with you, the fee increases by £55.

Number of applicants	Fee
You and 1 family member	£110
You and 2 family members	£165
You and 3 family members	£220

You and more than 3	Add £55 to the
family members	amount above for
	each additional
	family member

Please note that your application will be rejected as invalid if you do not pay the speciied fee.

Applications made on this form may not be made in person at the Public Enquiry Ofice of the Home Ofice.

How you can pay

You can pay by any of the following methods:

•Cheque/Bankers Draft

•Postal Order

•Credit card1 - 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.

1Please note that when making large or multiple payments using your credit card, the anti fraud measures that banks operate some- times stop the full payment being taken. This is because either the maximum limit on a sin- gle transaction, or the number of transactions allowed in a given period of time, has been exceeded. To prevent this you must ensure that you 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.

Cheques and postal orders

You must make the cheque or postal order payable to ‘Home Ofice’ 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 igures) 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 Section A of this form (Payment Details).

A1 Tick the fee appropriate to your application

-see above guidance. If you do not select a fee then we cannot take a payment and your application will be rejected as invalid.

A2-A3 If the address for correspondence is different from your home address in the UK, please give that address at A2. If a solicitor or other authorised immigration adviser is submitting the application, it should be their address at A2 and their name at A3. These details will also be used to acknowledge receipt of the application.

A4 Applicant’s full name, as given in his or her

passport or travel document.

A5 Applicant’s date of birth

Method of payment

A6 Tick one of the boxes to show which method of payment you are using

A7 - A9 If paying by cheque or bankers draft enter the bank account number, sort code and cheque number

Paying by credit / debit card

A10 The name as displayed on the credit/debit card

EEA3 Version 07/2013 - page 2 of 33

A11 Card number - this is the long number across the centre of the card

A12-A14 Enter the details where available on the card

A15 The Card Veriication Value (CVV) is a 3-digit security code found on the back of the card on the signature strip - it consists of the last 3 digits. For Amex the security code consists of 4-digits and is found on the front of the card.

AUTHORISED SIGNATURE

4567 123123

CVV

AMERICAN EXPRESS

CVV 1234 1234 1234 123456 12345

If you do not provide the CVV number, we cannot take your payment and your application will be rejected as invalid.

A16-A17 Cardholder’s signature - the person named on the credit/debit card must sign and date these sections.

Consideration process

•If the payment submitted does not cover the full cost of your application, it will be an invalid application and the form, together with any documentation submitted, will be returned to you.

•The fee charged is for the processing and consideration of the application. This fee

will be payable once the application form is received by the Home Ofice or its payment

processing agent, regardless of the outcome of the application.

•We cannot begin the consideration process until the payment has cleared. We allow 5 working days for payments made by cheque to clear, credit/debit cards and postal orders will clear immediately.

EEA3 Version 07/2013 - page 3 of 33

SECTION 1 - PAYMENT DETAILS EEA3

Please complete this section in block capitals and black ink.

A. Application Details

Applicants should refer to the Payment Guidance Notes which accompany this application form.

A1. Tick the applicable boxes and fee. If no fee is ticked we cannot take a payment and your application will be rejected as invalid:

Single applicant - no family members

£55

Main applicant and two family members

£165

Main applicant and one family member	£110	Main applicant and three family members	£220

If more than 3 family members are applying with you, please state the number in the space below

and enter the correct amount specified in the payment guidance in the box.

Main applicant and

family members

A2. Contact Address in the UK for correspondence

Postcode

A3. Contact Name in the UK if different from that of the applicant

A4. Applicant’s Full Name

A5. Applicant’s date of birth (dd/mm/yyyy) A6. Please select the method of payment from the list below:

United Kingdom postal order (payable to

‘Home Ofice’) - go to next section

Visa/Mastercard/Amex - go to question A10

Cheque/bankers draft (payable to

‘Home Ofice’) - go to question A7

Delta / Maestro - go to question A10

A7. Account number A8. Sort code A9. Cheque number

A10. Please debit the following account: Name on card

A11. Card number (the long number across the centre of the card)

A12. Valid from

A13. Expiry date

A14. Issue number

(where

available)

A16. Cardholder’s signature

A15.CVV security number

(3 digit number or 4 digit number for Amex)

A17. Date dd/mm/yyyy

EEA3 Version 07/2013 - page 4 of 33

FORM EEA3: GUIDANCE NOTES

There is no legal requirement for EEA or Swiss nationals to obtain a document certifying permanent resi- dence to confirm their right of residence in the UK. Any EEA or Swiss national applying for a document certifying permanent residence does so on an entirely voluntary basis.

1.WHO CAN APPLY ON THIS FORM

EEA or Swiss nationals exercising Treaty rights in the UK can apply for a document certifying perma- nent residence on this form. You may include your family members in the application if they are EEA or Swiss 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 Com- munity, its member states and the Swiss Confed- eration on the free movement of persons gives similar rights of residence to Swiss nationals and their family members. Any further reference on this form to EEA nationals includes Swiss nationals.

You and any family members included in the appli- cation must be in the UK to apply.

2.RELEVANT UK LEGISLATION

The relevant legislation for applications on this form is the Immigration (European Economic Area) Regulations 2006. You can find it on our website at www.ukba.homeoffice,gov.uk and also obtain a copy from HMSO.

To acquire the right to reside permanently in the UK, you need to have resided here in accordance with the EU laws relating to free movement rights that were in force for a continuous period of 5 years.

3. WHEN TO APPLY

You may apply at any time after residing here for a continuous period of 5 years in accordance with the EU laws relating to free movement rights that were in force during the 5-year period.

4.MAKING SURE YOUR APPLICA- TION IS COMPLETE

Your application could be delayed or even refused if it is incomplete. To avoid that, please ensure that you do the following:

•apply on the current version of form EEA3

•provide photographs of yourself and any fam-

ily members applying with you in the format specified in the separate Home Office guid- ance

•provide all relevant documents specified in the form

•complete every section of the form as re- quired

•sign and date the declaration at section 12.

We reserve the right to decide your application on the basis of the information and documents provided. It is important, therefore, to provide an explanation if you cannot give us all relevant infor- mation or documents when making your applica- tion.

Depending on the facts of each case and where appropriate, The Home Office may make an un- announced home visit. Equally, the Agency may prosecute the appropriate party if evidence of de- ception is discovered related to this application.

5.COMPLETING THE FORM

Please use a black pen to complete the form,

and write names, addresses and similar details in capital letters. In the applicant’s details and other

sections where you give personal details and ad- dresses, leave an empty box between each name and each part of the address.

Please note that we always use the personal de- tails in an applicant’s passport or identity card for

official purposes, including any document certifying permanent residence issued if the application is successful.

Take care to complete all sections as required. You must enclose a letter of explanation if you are unable to complete any part of the form because you do not have the required information.

If you need help with any of the questions you can seek advice by telephoning 0845 010 5200.

6.PHOTOGRAPHS

You must provide the following photographs:

•Two identical passport-size colour photo- graphs of yourself with your full name written

EEA3 Version 07/2013 - page 5 of 33

FORM EEA3: GUIDANCE NOTES

on the back of each one.

•Two identical passport-size colour photo- graphs of any family members applying with you with their full name written on the back of each one.

The photographs you provide must be in the format specified in the separate photograph guidance.

Please ensure that you place the photographs in a small sealed envelope attached to section 1 of the form as instructed there – and without any staples, clips, pins or anything else which could mark the photographs.

The photograph(s) provided will be reproduced in your and your family members’ document certify-

ing permanent residence if the application(s) is/are successful.

7.DOCUMENTS

Identity and travel documents provided with the ap- plication must be originals and copies will not be accepted.

Copies of other types of document of any kind are not acceptable unless there are valid reasons for not being able to provide the original document. In such circumstances, we may accept a copy certi- fied by the body or authority which issue the origi- nal (for example, a copy of a savings book certified by the building society or bank) or by a notary.

The reason for not being able to provide the origi- nal document must be explained in a covering letter. We are unlikely to be able to grant your ap- plication without the original document where there is no valid 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 ADDRESS

The address to which you must post an application on form EEA3 is:

Home Office

European Applications EEA3

PO Box 590

Durham

DH99 1AD

Posting it to any other address will delay it.

Please also use this address for any other corre- spondence 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 docu- ments to be returned to you by secure post you should enclose a pre-paid self-addressed Royal Mail Special Delivery (or Recorded Signed For delivery) envelope with your application. The pre- paid self-addressed envelope should be sufficient to accommodate the size and weight of your docu- ments and be insured to the appropriate level for the value of your documents. If this is not enclosed your documents will be returned to you using Royal Mail 2nd class post. Please consult Royal Mail’s website at www.royalmail.com for further in- formation.

9.DECISION TIMES

For information on the current processing times for applications for a document certifying permanent residence on form EEA3, see the ‘Applying under

European law’ page on our website.

10.CONTACTING US AFTER YOU HAVE APPLIED

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

To send us more information about your applica- tion, write to the address in part 8 and give the fol- lowing 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 your passport. However if you need your passport because you have to travel urgently and unexpectedly, call 0845 010 5200 and provide the personal and other de-

EEA3 Version 07/2013 - page 6 of 33

		FORM EEA3:	GUIDANCE NOTES

tails listed immediately above.
			* A document issued by the Turkish Republic of
			Northern Cyprus does not establish that the per-
11.	OBTAINING ANOTHER FORM		son is an EEA national. Only a document issued
You can obtain all the EEA application forms via			by the Republic of Cyprus stating that the holder

the Home Office website www.ukba.homeoffice.			is a national of the Republic of Cyprus establishes

gov.uk. For enquiries about immigration and re-			that the person is an EEA national and accordingly

lated matters, you can call our Customer Contact			entitled to free movement within the European

Centre on 0845 010 5200.			Union (EU).

			** Bulgaria and Romania joined the EU on 1 Janu-
12.	YOUR RIGHT TO RESIDE IN THE UK		ary

EEA nationals have a right to reside in the UK			2007. Guidance and application forms for Bulgar-
			ian and Romanian nationals are to be found at
for longer than 3 months if they are exercising a
			www.workingintheuk.gov.uk.
Treaty right in one of the following ways:

•	Worker		*** From 1 May 2004 until 30 April 2011 nationals
			of Czech Republic, Estonia, Hungary, Latvia, Lith-
•
	Self-employed		uania, Poland, Slovakia and Slovenia (known as
•	Student		A8 countries) who wished to exercise their Treaty
			rights in the UK as a worker were required to reg-
• Economically self-sufficient (including retired
			ister their employment under the Worker Regis-
	people)		tration Scheme (WRS) for a period of 12 months

•	Jobseeker		unless they were exempt.
•	Incapacitated		If you are applying for a document certifying per-
The following nationals may exercise Treaty rights			manent residence and your continuous 5-year
			period of residence in the UK in accordance with
in the UK:
			the regulations includes a period when you were

			required to be registered on WRS then you must
Austria		Belgium	provide evidence of this as stated in section 10.
			If you cannot show that you were registered as

Bulgaria**		Cyprus*	required then you will not be issued a document
Czech Republic***		Denmark	certifying permanent residence.

Estonia***		Finland	Alien passports are issued to persons of Russian
			origin who moved to the Baltic States, Estonia,
France		Germany
			Latvia and Lithuania, when they were part of the

Greece		Hungary***	former Soviet Union. They are not regarded as
Iceland		Irish Republic	being citizens and therefore the Estonian, Lithua-
			nian, and Latvian authorities issue them with alien

Italy		Latvia***	passports.
Liechtenstein		Lithuania***	Although they look very similar, alien passports
Luxembourg		Malta	are not proof of EEA nationality.

Netherlands		Norway	13.	TELEPHONE ENQUIRIES

Poland***		Portugal	For enquiries about immigration and related
			matters, you can call our Immigration Enquiry
Romania**		Slovakia***
			Bureau on 0870 606 7766.

Slovenia***		Spain	14.	OTHER EEA FORMS

Sweden		Switzerland (but see	The other EEA forms are:
		part 1 of these notes)
			EEA1 for registration certificate applications by

			EEA nationals and their EEA national family mem-

EEA3 Version 07/2013 - page 7 of 33

FORM EEA3: GUIDANCE NOTES

bers.

EEA2 for residence card applications by non-EEA national family members of EEA nationals.

EEA4 for permanent residence applications by non- EEA national family members of EEA nationals.

15.CHOOSING AN IMMIGRATION ADVISER

If you use the services of an immigration adviser, take care when choosing one. The Office of the Im- migration Services Commissioner (OISC) regulates immigration advisers. Their website at www.oisc. gov.uk contains a list of authorised advisers. It also has links to websites for solicitors, barristers and legal executives.

If you have a complaint about an immigration ad- viser or need other information, the OISC contact details are:

Office of the Immigration Services Commissioner

5th Floor

Counting House

53 Tooley Street

London

SE1 2QN

Telephone: 0845 000 0046

Alternatively the Solicitors Regulation Authority, which regulates solicitors in England and Wales, can help 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 com- plaints about a solicitor are:

Legal Complaints Service

Victoria Court

8 Dormier Place

Leamington Spa

Warwickshire

CV32 5AE

Telephone: 0845 608 6565

16.COMPLAINTS ABOUT OUR SERVICE

If you wish to make a complaint about our service, please refer to the complaints page on our website for detailed information about how to do so.

If you are unable to access the website or if you

need further advice after reading the information on the complaints page, please telephone our con- tact centre on 0845 010 5200.

17.DATA PROTECTION NOTICE

We will treat all information provided by you in confidence but may disclose it to other govern- ment departments, agencies, local authorities, the police, foreign governments and other bodies for immigration purposes or to enable them to carry out their functions.

We may also use the information provided by you for training purposes.

EEA3 Version 07/2013 - page 8 of 33

EEA3

PERMANENT

RESIDENCE

SECTION 1 – APPLICANT’S DETAILS

Please complete section 1 and 2 with your details and those of any family members also apply- ing on this form. If you are applying as the family member of an EEA national who is, or was, exercising Treaty rights in the United Kingdom, please complete Section 3 with their details and then complete Section 4, 5 or 6 as appropriate.

1.1 Your title - please tick

Mr		Mrs		Miss

1.2If other, what is your title?

1.3Your gender – please tick

Male		Female

1.4Your date of birth day month year

Ms		Other

Photographs

You must provide two identical photographs of yourself with your full name on the back of each one. Please place the photographs in a small sealed envelope, together with those of any family members included in section 2, and attach it across this space with a staple or paper clip at the right- hand side of the page/envelope.

Please make sure that the staple or paper clip does not damage or mark the photographs. All photo- graphs must be as specified in the separate photo- graph guidance.

1.5Your full name as in your passport or ID card

1.6Surname or family name as in your passport or ID card

1.7Any other name(s) by which you have been known

1.8Nationality

1.9 Do you also hold British citizenship

Yes

1.10 Place of birth – town or city and country

EEA3 Version 07/2013 - page 9 of 33

1.11 Passport or travel document number

1.12 Home Office reference (if applicable)

1.13 Your UK address – please inform us if this changes

Postcode

1.14 Your daytime telephone number

1.15 Your mobile telephone number

1.16Your e-mail address if you have one

1.17Name and address in the UK for all correspondence about your application if different from

Postcode

1.18if you completed 1.17 and the address is that of your immigration adviser, please state their Office of the Immigration Services Commissioner (OISC number)

EEA3 Version 07/2013 - page 10 of 33

SECTION 2 – FAMILY MEMBERS INCLUDED IN YOUR APPLICATION

Please give details below of any EEA national family members included in the application. If more than 3 family members are applying, please give their details on a photocopy of this page, enclose it with the form, and place the photographs in the envelope attached to section 1 as instructed there. Non-EEA national family members wishing to apply for permanent residence should complete form EEA 4.

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), please provide appropriate documentary evidence to confirm the relationship (e.g. full birth, marriage or civil partnership certificates).

Photographs You must provide two identical pho- tographs of each family member who is applying.

Write the fam- ily member’s full

name on the back of each photograph and enclose both photographs in the envelope attached to section 1 as instructed there.

Photographs You must provide two identical pho- tographs of each family member who is applying.

Write the fam- ily member’s full

name on the back of each photograph and enclose both photographs in the envelope attached to section 1 as instructed there.

Photographs You must provide two identical pho- tographs of each family member who is applying.

Write the fam- ily member’s full

name on the back of each photograph and enclose both photographs in the envelope attached to section 1 as instructed there.

2.1Family member’s full name

2.2Nationality

2.3 Date of birth

2.4 Gender -

2.5 Relationship

please tick

to you - please

day month

year

specify

male female

2.6Home Ofice reference (if applicable)

2.7Family member’s full name

2.8Nationality

2.9 Date of birth

2.10 Gender

2.11 Relationship

- please tick

to you - please

day month

year

specify

male female

2.12Home Ofice reference (if applicable)

2.13Family member’s full name

2.14Nationality

2.15 Date of birth

2.16 Gender

2.17 Relationship

- please tick

to you - please

day month

year

specify

male female

2.18 Home Ofice reference (if applicable)

EEA3 Version 07/2013 - page 11 of 33

SECTION 3 – YOUR EEA NATIONAL FAMILY MEMBER WHO IS EXERCISING

TREATY RIGHTS

Please give the personal details of your EEA national family member who has been exercising Treaty rights in the UK, or who has acquired permanent residence in the UK under the Immigration (European Economic Area) Regulations 2006. You must only complete this section if you are the family member of an EEA national who is exercising Treaty rights in the UK and they have chosen not to apply for a document certifying permanent residence at this time.

Note 1. There is no requirement for your EEA national family member to apply for a document certifying 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 national family member wishes to apply for a document certifying permanent residence their details must be entered in section 1 and your details in section 2.

3.1 Their title – please tick	Mr		Mrs		Miss		Ms

If other, what is their title?

3.2 Their full name as in their passport or ID card

Other

3.3Surname or family name as in their passport or ID card

3.4Any other name(s) by which they are or have been known

3.5Nationality

3.6Do they also hold British citizenship?

3.7Their date of birth

day month					year

3.9 Home Office reference if they have one

Yes		No

3.8 Their gender – please tick

male		female

3.10Passport, ID card or registration certiicate number

3.11 Their UK address – please inform us if this changes

Postcode

3.12

Their daytime telephone number

3.13 Their mobile telephone number if they have one

3.14

Their relationship to you

EEA3 Version 07/2013 - page 12 of 33

SECTION 3 – YOUR EEA NATIONAL FAMILY MEMBER WHO IS EXERCISING

TREATY RIGHTS (continued)

3.15Evidence of relationship: birth certiicate/marriage certiicate/civil partnership certiicate/evi- dence of durable relationship/other evidence of relationship (please circle to indicate).

Note 2. If you are applying for a document certifying permanent residence and during the 5-year continuous residence period your EEA national family member has died or left the UK, please complete section 4.

If you are applying for a document certifying permanent residence because your EEA national family member who was exercising Treaty rights as a worker or self-employed person has died but you have been resident in the UK for less than 5 years please complete section 5.

If you are applying for a document certifying permanent residence on the basis that your UK national family member is treated as an EEA national under the judgment in the case of Surinder Singh, please complete section 6.

Please go straight to section 7 for all other applications.

EEA3 Version 07/2013 - page 13 of 33

SECTION 4 - RETAINED RIGHT OF RESIDENCE IN THE UK

You must complete this section if you are applying for a document certifying permanent resi- dence because your EEA national family member has died or left the UK. You must also com- plete section 7, to show how your EEA national family member was exercising treaty rights.

4.1 Reason for having a retained right of residence in the UK. Please tick relevant box:

EEA national family member has died

(Answer only 4.2 to 4.6)

EEA national has left the UK

(Answer only 4.7 to 4.11)

day month year

4.2 Date your EEA national family member died:

4.3	Are you a child or grandchild of the EEA national who	Yes
has died? If no go to 4.4. If yes, go straight to 4.5
4.4	Are you the parent with custody of a child or grand-	Yes
child of the EEA national family member who has died?
4.5	Was the child or grandchild attending an educational	Yes
course immediately before the EEA national family mem-
ber died and do they continue to attend such a course?

4.6Please give details in the box below of which educational establishment they are attending. You must also provide evidence of this such as a letter from the school or college. Then go to section 6.

day month year

4.7 Date your EEA national family left the UK:

4.8 Are you a child or grandchild of the EEA national who	Yes
has left the UK? If no go to 4.9. If yes, go straight to 4.10
4.9 Are you the parent with custody of a child or grand-	Yes
child of the EEA national family member who has left the
UK?
4.10 Was the child or grandchild attending an educa-	Yes
tional course immediately before the EEA national family
member left the UK and do they continue to attend such a
course?

4.11Please give details in the box below of which educational establishment they are attend- ing. You must also provide evidence of this such as a letter from the school or college. Then go to section 6.

EEA3 Version 07/2013 - page 14 of 33

SECTION 5 – PERMANENT RESIDENCE DUE TO DEATH OF EEA NATIONAL

FAMILY MEMBER

You must complete this section if you are applying for a document certifying permanent resi- dence because your EEA national family member who was working or self-employed has died but you have been resident in the UK for less than 5 years. You must also complete section 7, to show how your EEA national family member was exercising Treaty rights.

5.1 Date your EEA national family member died:

day month year

5.2	Were you living with your EEA national family	Yes
member immediately before they died?
5.3	Had your EEA national family member lived in	Yes
the UK for at least the 2 years immediately before
they died?
5.4	Was your EEA national family member’s	Yes

death due to an accident at work or an occupa- tional disease?

EEA3 Version 07/2013 - page 15 of 33

SECTION 6 – PERMANENT RESIDENCE IN SURINDER SINGH CASES

You must complete this section if you are applying for a document certifying permanent resi- dence on the basis that your UK national family member is entitled to be treated as an EEA na- tional under the judgment in the case of Surinder Singh.

6.1Has your UK national family member exercised treaty rights as a worker or self-em- ployed person in another EEA member state?

Yes - as a worker

Yes - as a self-employed person

6.2 Were you the family member of the UK	Yes
national at a time when they were exercising
treaty rights as a worker or self-employed person
in another EEA member state?

6.3 Did you reside with your UK national family	Yes
member in that EEA member state at a time when
they were exercising treaty rights as a worker or
self-employed person?

You must provide evidence to show that you resided in the EEA member state at a time when your family member was exercising treaty rights in that EEA member state.

6.4EEA member state in which your UK national partner exercised treaty rights as a worker or self-employed person

6.5Date that your UK national family member commenced employment or self-employment in the other EEA member state.

day month year

6.6Date that your UK national family member ceased employment or self-employment in the other EEA member state.

day month year

6.7Date you began residing with your UK national family member in the EEA member state in which they exercised treaty rights as a worker or self-employed person.

day month year

EEA3 Version 07/2013 - page 16 of 33

6.8 Date of your return to the UK

day month year

6.9 Date of your family member’s return to the UK

day month year

If your UK national family member exercised treaty rights as a worker in another EEA member state please complete questions (6.10) to (6.13). Then go to section 8.

If your UK national family member exercised treaty rights as a self-employed person in another EEA member state please complete questions (6.14) to (6.17). Then go to section 8.

Please provide details of how your UK national family member exercised Treaty rights as a worker in another EEA member state.

6.10Full name of employer (i.e. business or firm)

6.11Address of the business where your UK national family member was employed

Postcode

6.12 Business telephone number

6.13Evidence of employment. Please provide us with at least one of the following types of evi- dence and tick relevant box(es)

Contract(s) of employment

Wage slips

Letter(s) from employer confirming employment. This should be on letter headed paper and signed and dated by your UK national family member’s former employer.

EEA3 Version 07/2013 - page 17 of 33

Evidence that your UK national family member exercised Treaty rights as a self- employed person in another EEA member state

6.14Name of business

6.15Business address

Postcode

6.16Evidence of self-employment/business. Please provide at least one of the following documents:

Invoices/receipts

Business bank statements

6.17 Additionally you can also provide:

Accountant’s letter

A lease on business premises (if applicable)

Evidence that you paid tax or social security contributions (or equivalent) in the country where you were self-employed (for example, personal tax return).

EEA3 Version 07/2013 - page 18 of 33

SECTION 7 – DETAILS OF THE EXERCISE OF TREATY RIGHTS FOR 5 YEARS

To qualify for permanent residence an EEA national must have continuously exercised a Treaty

right in the UK for 5 years through employment, seeking work, self-employment, study, or econom- ic self-suficiency unless you are qualifying on the basis of a family member of an EEA national. In

all cases, please complete the section below with details of the EEA national who is exercising the Treaty right. If you/your EEA national family member have been supported by the employment or funds of a family member you/they may still qualify. If you/your EEA national family member have resided in the UK for less than 5 years but have stopped working or being self-employed due to early retirement, reaching state pension age or permanent incapacity, you/they may still qualify

for permanent residence The details given in this section must be supported by the documentary evidence speciied in section 11.

7.1Please tick one or more of the boxes below to show the way(s) in which you/your EEA national family member has exercised Treaty rights for the past 5 years and give relevant dates.

FromTo

Employment

Self-Employment

Seeking work

Economic self-suficiency (including retirement)

Study

Stopped work due to retire- ment or Permanent incapac- ity

Temporarily incapacitated

Unemployed or undertaking vocational training

7.2If you/your EEA national family member did not exercise Treaty rights for some or all of this

period but was supported by the employment or funds of a family member, or if there are any other periods of time not accounted for in the above table, please give details below. Continue on a separate sheet if necessary and enclose it with this form.

EEA3 Version 07/2013 - page 19 of 33

SECTION 7 – DETAILS OF THE EXERCISE OF TREATY RIGHTS FOR 5 YEARS

(continued)

7.3If your EEA national family member exercised Treaty rights in employment, self-employment or study, please give details below starting with the most recent if there is more than one employer and/or place of study. Continue on a separate sheet if necessary and enclose it with this form.

Name and address of employer or place of study

From

Until

Type of business if self employed

EEA3 Version 07/2013 - page 20 of 33

SECTION 8 – TIME SPENT OUTSIDE THE UK

To qualify for permanent residence you need to have resided in the UK continuously for 5 years unless you are applying on the basis that you stopped working or being self-employed due to early retirement, reaching state pension age or permanent incapacity. Time spent outside the UK which does not exceed 6 months in total in any year and absences due to special circum- stances will not affect your period of residence.

8.1Please give the date and place of your first arrival in the UK for yourself and any family members mentioned in section 2. Continue on a separate sheet if necessary and enclose it with this form.

Name	Date of first arrival			Place of first arrival
	day	month	year

8.2Please complete the table below for yourself and any family members mentioned in section 2 to show any time you have spent outside the UK during the 5 years you/your EEA national family member have been exercising Treaty rights. When counting the number of days absent do not include the day of departure or the day of return. Continue on a separate sheet if neces- sary and enclose it with this form.

Name of person(s)	Country or coun-	Date of departure	Date of return to	Number of
absent from the UK	tries visited	from UK	UK	days

EEA3 Version 07/2013 - page 21 of 33

SECTION 8 – TIME SPENT OUTSIDE THE UK (continued)

8.3If any of the absences mentioned above exceed 6 months in any year please explain below the reasons why you were absent from the UK. Continue on a separate sheet if necessary and enclose it with this form.

EEA3 Version 07/2013 - page 22 of 33

SECTION 9 - PERSONAL HISTORY

Personal History (criminal convictions, war crimes, etc.)

Please provide details as requested below of any criminal convictions you may have both in the UK and overseas. However, please note that should you fail to provide this information this will not result in the rejection of your application. Please note that it is an offence under Section 26(1)(c) of the Immigration Act 1971 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 criminal offence in the UK or any other country?

Yes

- go to question 9.2

- go to question 9.3

9.2.Please give details below for each criminal conviction, starting with the most recent one. If you or any family members who are applying with you have received more than two convictions, please photocopy this page and enclose it with this form.

Note: We will carry out criminal record checks on all applicants and family members. You must give details of all unspent and spent criminal convictions. This includes road trafic offences but not ixed penalty 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 1

Country where convicted

Nature of the offence

Sentence given

Date sentenced

If you or any family members who are applying with you were sentenced to a period of imprisonment, what was the length of the prison sentence imposed (in months)?

Criminal conviction 2

Country where convicted

months

EEA3 Version 07/2013 - page 23 of 33

SECTION 9 - PERSONAL HISTORY

Nature of the offence

Sentence given

Date sentenced

D D

M M

Y Y Y Y

If you or any family members who are applying with you were sentenced to a period of imprisonment, what was the length of the prison sentence imposed (in months)?

Yes		go to 9.4
9.3. Do you or any family members who are applying
9.3. Do you or any family members who are applying
with you have any civil judgments against you or
any civil penalty under the UK Immigration Acts?		go to 9.5
any civil penalty under the UK Immigration Acts?
No

months

9.4.Give details for each civil judgment or any civil penalty under UK the Immigration Acts, starting with the most recent one.

If you or any family members who are applying with you have received more than two civil judgments and/or civil penalties under the UK Immigration Acts, please photocopy this page and enclose it with this form.

Details of judgment or civil penalty 1

Date of judgment or civil penalty

Country where judgment made

D D

M M

Y Y Y Y

Details of judgment or civil penalty 2

Date of judgment or civil penalty

Country where judgment made

D D

M M

Y Y Y Y

EEA3 Version 07/2013 - page 24 of 33

You 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 deinitions at the end of this section.

	9.5. Have you or any family members who are applying with you	Yes
	ever been charged in any country with a criminal offence for	Yes

	which you have not yet been tried in court?
	9.6. In times of either peace or war have you or any family	Yes
	members who are applying with you ever been involved, or
	suspected of involvement, in war crimes, crimes against
	humanity or genocide?
	9.7. Have you or any family members who are applying with	Yes
	you ever been involved in, supported or encouraged terrorist
	activities in any country?
	9.8. Have you or any family members who are applying with you	Yes
	ever been a member of, or given support to, an organisation
	which has been concerned in terrorism?
	9.9. Have you or any family members who are applying with you	Yes
	ever, by any means or medium, expressed views that justify
	or glorify terrorist violence or that may encourage others to
	terrorist acts or other serious criminal acts?
	9.10. Have you or any family members who are applying with you	Yes
	ever engaged in any other activities which might indicate that
	you may not be considered to be persons of good character?

9.11. How long have you lived in the UK?

Years

Months

Please provide details of any periods of absence of more than 6 months during that time.

Date you left the UK

Date you returned

to the UK

Reason for absence

EEA3 Version 07/2013 - page 25 of 33

9.12.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 years

You should tell us about any family, friends, or other connections with that country.

Country

Social cultural or family ties

9.13.If you have answered yes to question 9.5, 9.6, 9.7, 9.8, 9.9 or 9.10, you must give further details in the space provided below. If you need more space, continue on a separate sheet and enclose it with this form.

EEA3 Version 07/2013 - page 26 of 33

SECTION 9 – PERSONAL HISTORY

DEFINITIONS

For the purposes of answering questions 9.5 to 9.10 the following information provides guidance on actions which may constitute war crimes, crimes against humanity, genocide or terrorist ac- tivities.

This guidance is not exhaustive. The full definitions of war crimes, crimes against humanity and genocide can be found in Schedule 8 of the International Criminal Court Act 2001 at www.opsi. gov.uk/acts/acts2001/ukpga_20010017_en_1 or purchased from The Stationery Office (tel- ephone 0870 600 5522). It is your responsibility to satisfy yourself that you are familiar with the definitions and can answer the questions accurately on behalf of yourself and any family mem- bers who are applying with you.

War crimes

Grave 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 con- stitute a war crime include wilful killing, torture, extensive destruction of property not justified by military necessity, unlawful deportation, the intentional targeting of civilians and the taking of hostages.

Crimes against humanity

Acts committed at any time (not just during armed conflict) as part of a widespread or systematic attack, directed against any civilian population with knowledge of the attack. This would include offenses such as murder, torture, rape, severe deprivation of liberty in violation of fundamental rules of international law and enforced disappearance of persons.

Genocide

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

Terrorist activities

Any act committed, or the threat of action, designed to influence a government of 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 damages to property, or is de- signed to seriously disrupt or interfere with an electronic system.

Organisations concerned in terrorism

An organisation is concerned in terrorism if it commits or participates in acts of terrorism, pre- pares for terrorism, promotes or encourages terrorism (including the unlawful glorification of ter- rorism), or is otherwise concerned in terrorism.

EEA3 Version 07/2013 - page 27 of 33

SECTION 10 – PHOTOGRAPHS

You must provide the relevant photographs specified below. They must be in the format speci- fied in the separate Home Office photograph guidance. If they are not, they may be rejected as unacceptable and you will have to provide others which are acceptable. This will delay consid- eration of your application.

Tick the relevant box(es) to confirm the photographs you are providing and enclose them in a small sealed envelope attached to section 1 as instructed there.

Two recent identical colour passport-size photographs of yourself with your name written on the back of each one. Please see the guidance notes for information on what types of photograph are acceptable.

Two recent identical colour passport-size photographs of each family member included in section 2 for whom a document certifying permanent residence is re- quired, with their name written on the back of each one.

SECTION 11 – DOCUMENTS

For your application to be complete, you must provide the documents specified below which are relevant to your application. If you do not, we reserve the right to decide your application on the basis of the information and documents provided. Tick the relevant box(es) to show the docu- ments you are providing.

The documents must be originals. Any which are not in English must be accompanied by a reli- able English translation.

Please note that in some cases, we may have to ask for other documentation in addition to those specified below.

Your current passport or ID card. 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 pass- port or ID card, you must provide another form of identity.

The current passport(s) or ID card(s) of each family member included in section 2 for whom a document certifying permanent residence is required. If they do not have a passport or ID card, you must provide another form of identity.

If Section 4 (Retained Rights) has been completed: evidence as applicable such as your EEA national family member’s death certificate or proof they have left the

UK. Proof of a child or grandchild attending an educational course.

If Section 5 (Permanent residence due to death of EEA national family member) has been completed: evidence of your EEA national working or being self employed as stated in the relevant sections below. Proof that you resided with them im- mediately prior to their death. Proof that your EEA national family member lived in the UK for at least the 2 years prior to their death as stated in the relevant section below or that their death was as a result of an accident at work or occupational disease such as their death certificate.

EEA3 Version 07/2013 - page 28 of 33

If section 6 (Surinder Singh cases) has been completed: evidence that you and your UK national family member resided in another EEA member state at a time when they were a worker or self-employed person in that member state, such as tenancy agreements, bank statements, utility bills. Evidence that you and your UK national family member have resided continuously in the UK following your return from the EEA state in which your UK family member was a worker or self-employed person.

For time spent in employment: this can include contracts of employment, letter(s) from your employer(s) confirming your employment, wage slips or P60s covering the

5-year continuous residence should be provided. These should feature a full National Insurance Number rather than a temporary one. If you were required to be registered on the Worker Registration Scheme or to hold an accession worker authorisation document at any time during your 5-years continuous residence, you must provide your worker registration card and all worker registration certificates, or your worker authorisation document(s) (for example, your accession worker card), together with proof of your employment with each employer named on the certificate or card.

For time spent in self-employment: this can include evidence to show you are self-employed, e.g. a lease on business premises, HM Revenue and Customs (HMRC) self-assessment forms, business bank statements, invoices or receipts or National In- surance contributions.

For time spent as a student: Evidence of a school, college or university letter con- firming enrolment on a course of study, evidence of comprehensive sickness insurance (see section below on comprehensive sickness insurance) and evidence of funds avail- able to you such as a bank statement, a document confirming the receipt of a grant or scholarship, or a declaration of sufficient funds.

For time spent as economically self-sufficient: this can include evidence of com- prehensive sickness insurance for yourself and any family members included in your application (see section below on comprehensive sickness insurance) and of funds to show you are economically self-sufficient, e.g. a bank statement. If these funds come from a family member, evidence of their employment or funds should be supplied. Evi- dence to show you are retired, e.g. document(s) confirming the receipt of a pension.

For time spent seeking work: this can include evidence of your unemployment such as letters from your last employer. Evidence that you have registered as unemployed with Jobcentre Plus or a recruitment agency. Evidence of seeking work e.g. copies of application forms or letters of rejection or invite to interview from potential employers. Evidence of vocational or academic qualifications.

If you have stopped working or being self-employed due to permanent in-

capacity: this can include evidence to show you are permanently incapacitated, e.g. a consultant’s letter or medical report confirming permanent incapacity along with proof

of having previously been in employment or self-employment. You must also provide proof of either residing in the UK for the 2 years immediately before you stopped work or being self-employed, or proof that your incapacity is as a result of an accident at work or occupational disease that entitles you to a pension paid in full or part by an institution in the UK.

EEA3 Version 07/2013 - page 29 of 33

If you have stopped working or being self-employed due to early retirement or reaching state pension age: this can include proof that you have resided in the UK for at least the 3 years immediately before you retired and that you were working or self-employed for at least 12 months immediately before you retired.

As evidence of comprehensive sickness insurance (This requirement only applies to persons exercising Treaty rights as students or self-sufficient per- sons.):

You must provide either a private comprehensive sickness insurance policy document that covered for medical treatment in the majority of circumstances, or a European Health Insurance Card (EHIC) that covered the 5-year period of residence in the UK.

As evidence of residence in the UK by you and your family members both currently and continuously over 5 years:

Proof of residence: this can include tenancy agreements, utility bills and bank state- ments. For children this could include letters from their school.

As evidence of relationships:

For family relationships: this can include marriage certificates, civil partnership cer- tificates or birth certificates.

For unmarried partners: proof that you continue to be in a durable relationship. Such as joint bank or building society statements, joint tenancy agreements, council tax bills or evidence that you have both continued to pay utility bills at the property at which you reside.

EEA3 Version 07/2013 - page 30 of 33

SECTION 12 – DECLARATION

Please read the declaration below and sign it. It should be signed by you (the applicant) and not by a representative or other person acting on your behalf. If you are under 18, your parent or guardian should sign it.

I hereby apply for a document certifying permanent residence for myself and any EEA national family members listed in this form. The information I have given in this form is complete and is true to the best of my knowledge.

I confirm that the photographs submitted with this form are a true likeness of myself and any family members applying with me, as named on the back of each photograph, and that I have had the opportunity to see the Home Office photograph guidance.

I confirm that if, before this application is decided, there is a material change in my circum- stances 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 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 per- form their functions, and that, if such bodies provide the Home Office with any information about me which may 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 agen- cies to prevent fraud and money laundering. I also understand that such agencies may provide the Home Office with information about me. Further details explaining when information may be passed to or from fraud prevention agencies and how that information can be used can be ob- tained on the Home Office website.

I understand that documents provided in support of this application will be checked for authentic- ity, 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.

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

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, or to obtain, or seek to obtain a document certifying permanent resi- dence by means which include deception.

Signed

Date

EEA3 Version 07/2013 - page 31 of 33

PHOTOGRAPHS AND DOCUMENTS CHECKLIST

Please complete this part of the form to help us check that we have received your photographs and documents and to keep a record of them while they are with us. At ‘A’ tell us how many of each of the listed items you are providing with your application. At ‘B’ list any other documents

provided by you and state how many in each case. Continue on a separate sheet if necessary and enclose it with this form. All documents must be originals.

A. Listed items

How many?

B. Other documents

How many?

Photographs of yourself

Photographs of any family members

Passport or ID cards

Contracts of employment/employers letter/wage slips/P60s

A lease/HMRC form/NI contributions/

Accountants letter

Bank statements/invoices/receipts

School/college/university letter

Comprehensive sickness insurance document/EHIC

Pension document

Consultant’s letter/medical report

Evidence of funds

Utility bills/tenancy agreements

Birth/Marriage/Civil Partnership certifi- cates

EEA national family member’s death certificate/ proof they have left the UK

Please note that, in some cases, we may have to ask for other documents in addition to those specified in this form

EEA3 Version 07/2013 - page 32 of 33

FINAL CHECKLIST

To ensure that your application is complete, please make the following checks before posting it. Tick each box that is relevant to your application.

Is EEA3 the right form for you and is it valid for use? See date on front page

Have you paid the specified fee? See pay- ment guidance notes.

Have you completed all relevant sections of the form as specified?

Have you sent the documents and photographs specified in section 10 and 11 as listed above?

Current passport(s) or ID cards(s) includ- ing those for family members

Worker registration card and all worker registration certificate(s)

Have you, or your parent/guardian if you are under 18, signed and dated the decla- ration in section 12?

Photographs

All other relevant documents specified in section 11

If you are unable to send us any of the documents specified in section 11 which are relevant to your application have you given an explanation and said when you will be able to send them?

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

Home Office

European Applications -EEA3

PO Box 590

Durham

DH99 1AD

EEA3 Version 07/2013 - page 33 of 33

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