Complete all sections as required including the Personal History section.

(1)

AApppplliiccaattiioonn ffoorr aa rreeggiissttrraattiioonn cceerrttiiffiiccaattee iinn tthhee UUKK bbyy::

EEuurrooppeeaann EEccoonnoom

miicc AArreeaa ((EEEEAA)) nnaattiioonnaallss aanndd tthheeiirr EEEEAA oorr

EEuurrooppeeaann EEccoonnoom

miicc AArreeaa ((EEEEAA)) nnaattiioonnaallss aanndd tthheeiirr EEEEAA oorr

SSwwiissss nnaattiioonnaall ffaam

miillyy m

meem

mbbeerrss rreessiiddiinngg iinn tthhee UUKK

SSwwiissss nnaattiioonnaall ffaam

miillyy m

meem

mbbeerrss rreessiiddiinngg iinn tthhee UUKK

oorr

SSwwiissss nnaattiioonnaallss aanndd tthheeiirr SSwwiissss oorr EEEEAA nnaattiioonnaall ffaam

miillyy

SSwwiissss nnaattiioonnaallss aanndd tthheeiirr SSwwiissss oorr EEEEAA nnaattiioonnaall ffaam

miillyy

m

meem

mbbeerrss rreessiiddiinngg iinn tthhee UUKK

m

meem

mbbeerrss rreessiiddiinngg iinn tthhee UUKK

VVeerrssiioonn 1111//22000077

TThhiiss ffoorrm

m iiss

ttoo bbee uusseedd ffoorr

aapppplliiccaattiioonnss

m

maaddee oonn oorr aafftteerr

1155 NNoovveem

mbbeerr 22000077

EEEEAA11

RREEGGIISSTTRRAATTIIOONN

CCEERRTTIIFFIICCAATTEE

TTHHEE AADDDDRREESSSS TTOO WWHHIICCHH YYOOUU MMUUSSTT PPOOSSTT TTHHEE AADDDDRREESSSS TTOO WWHHIICCHH YYOOUU MMUUSSTT PPOOSSTT YYOOUURR AAPPPPLLIICCAATTIIOONN OONN FFOORRMM EEEEAA11 IISS:: YYOOUURR AAPPPPLLIICCAATTIIOONN OONN FFOORRMM EEEEAA11 IISS::

HHoommee OOffffiiccee

EEuurrooppeeaann AApppplliiccaattiioonnss EEEEAA11 PP..OO.. BBooxx 330066

DDeepptt 4455 LLiivveerrppooooll LL22 00QQNN

BBUUIILLDDIINNGG AA SSAAFFEE,, JJUUSSTT AANNDD TTOOLLEERRAANNTT SSOOCCIIEETTYY

FFoorr iinnffoorrm

maattiioonn aabboouutt tthhee ootthheerr EEEEAA ffoorrm

mss,, sseeee ppaaggee 44..

IIff yyoouu nneeeedd hheellpp iinn ccoom

mpplleettiinngg tthhiiss ffoorrm

m tteelleepphhoonnee 00887700 660066 77776666..

(2)

FFOORRM

M EEEEAA11:: GGUUIIDDAANNCCEE NNOOTTEESS

TTHHEERREE IISS NNOO LLEEGGAALL RREEQQUUIIRREEMMEENNTT FFOORR EEEEAA AANNDD SSWWIISSSS NNAATTIIOONNAALLSS TTOO OOBBTTAAIINN AA RREEGGIISSTTRRAATTIIOONN CCEERRTTIIFFIICCAATTEE TTOO CCOONNFFIIRRMM TTHHEEIIRR RRIIGGHHTT OOFF RREESSIIDDEENNCCEE IINN TTHHEE UUKK.. TTHHIISS IISS AA VVOOLLUUNNTTAARRYY RREEGGIISSTTRRAATTIIOONN

PPRROOCCEESSSS FFOORR WWHHIICCHH YYOOUU SSHHOOUULLDD UUSSEE FFOORRMM EEEEAA 11 IIFF YYOOUU WWIISSHH TTOO AAPPPPLLYY

11 FFOORR WWHHIICCHH AAPPPPLLIICCAATTIIOONNSS SSHHOOUULLDD YYOOUU UUSSEE FFOORRMM EEEEAA11??

TToo aappppllyy ffoorr aa rreeggiissttrraattiioonn cceerrttiiffiiccaattee iiff yyoouu aarree aann EEEEAA nnaattiioonnaall eexxeerrcciissiinngg TTrreeaattyy rriigghhttss iinn tthhee UUKK. See part 15 of these notes for information about Treaty rights.

You may include your family members in the application if they are EEA or Swiss nationals.

TToo aappppllyy ffoorr aa rreeggiissttrraattiioonn cceerrttiiffiiccaattee iiff yyoouu aarree aa SSwwiissss nnaattiioonnaall rreessiiddiinngg iinn tthhee UUKK. You may include your family members in the application if they are Swiss or EEA nationals.

Although Switzerland is not a Member State of the EEA the Agreement between the European Community, its Member States and the Swiss Confederation on the free movement of persons gives similar rights of residence to Swiss nationals and their family members.

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

22 RREELLEEVVAANNTT UUKK LLEEGGIISSLLAATTIIOONN

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

33 WWHHOO CCAANN AAPPPPLLYY OONN TTHHIISS FFOORRMM??

Only EEA or Swiss nationals and their EEA or Swiss family mem-bers residing in the UK.

44 WWHHEENN TTOO AAPPPPLLYY

You may apply at any time during your stay in the UK.

55 MMAAKKIINNGG SSUURREE YYOOUURR AAPPPPLLIICCAATTIIOONN IISS CCOOMMPPLLEETTEE

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

m

maakkee iitt oonn tthhee ccuurrrreenntt vveerrssiioonn ooff EEEEAA11

pprroovviiddee aallll tthhee pphhoottooggrraapphhss ooff yyoouurrsseellff aanndd aannyy ffaammiillyy mmeem m--bbeerrss 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 you complete the form.

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

CCoommpplleettee aallll sseeccttiioonnss as required including the Personal History section.

SSeeccttiioonn 11 This is where you give your own details. Leave a space between each name and part of the address(es) required in this section (do the same where names and addresses are required in other sections).

SSeeccttiioonnss 11 aanndd 22 It’s essential that you provide the photographs of yourself and any family members included in the application. Please use one staple or one paper clip in each person’s case to attach them within the spaces provided. Do not use glue or any other sticky adhesive. See part 7 below for more guidance on photographs.

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

AAllll sseeccttiioonnss If you are at present unable to provide any of the information or details requested in any of the relevant sections, please explain the reasons in a letter and enclose it with the application form. If you need help with any of the questions, you can seek advice by telephoning 00887700 660066 77776666.

SSeeccttiioonn 99 This section lists the documents and photographs which you have to provide. If you can’t provide any of the docu-ments specified in the application form, please explain why in a letter with the form and say when you will be able to provide them. See part 8 below for more guidance on documents. Ensure that your passport or identity card and those of any fam-ily members included in the application are signed as required. SSeeccttiioonn 1100 You must sign and date the declaration. If you don’t, it will delay your application.

77 PPHHOOTTOOGGRRAAPPHHSS

You must provide the following photographs:

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

TTwwoo iiddeennttiiccaall ppaassssppoorrtt--ssiizzee pphhoottooggrraapphhss ooff aannyy ffaammiillyy mmeem m--bbeerrss iinncclluuddeedd iinn tthhee aapppplliiccaattiioonn wwiitthh tthheeiirr nnaammeess wwrriitttteenn oonn tthhee bbaacckk ooff eeaacchh pphhoottooggrraapphh..

The photographs should be in colour, recent (within the last month), and approximately 45 millimetres high and 35 millime-tres wide, the size of a passport photo.

Each photograph must show the individual’s full face clearly against a light background. Sunglasses are not acceptable. Nor is any head covering unless this has to be worn for religious or cultural reasons. But if the covering conceals the face, this will not be acceptable.

If the application(s) is/are successful, the photograph(s) provid-ed will be reproducprovid-ed in your and your family members’ regis-tration certificate(s).

(3)

FFOORRM

M EEEEAA11 -- GGUUIIDDAANNCCEE NNOOTTEESS

88 DDOOCCUUMMEENNTTSS

AAllll ddooccuummeennttss pprroovviiddeedd wwiitthh tthhee aapppplliiccaattiioonn mmuusstt bbee oorriiggiinnaallss.. Exceptionally, a certified copy may be acceptable. The copy must be certified by the body or authority which issued the original (for example, a copy of a savings book certified by the building society or bank), or by a notary. The reasons for pro-viding a certified copy rather than the original document must be explained in covering letter.

Generally speaking, it is unlikely that we will be able to grant your application without seeing the original documents.

99 AAPPPPLLYYIINNGG BBYY PPOOSSTT -- TTHHEE AADDDDRREESSSS

If you are applying by post, the address to which you must post an application on form EEA1 is:

EEuurrooppeeaann AApppplliiccaattiioonnss EEEEAA11 PP..OO.. BBooxx 330066

DDeepptt 4455 LLiivveerrppooooll LL22 00QQNN

Posting it to any other address will delay it.

Please also use this address for any other correspondence about your application.

If you use Recorded or Special Delivery, this will help us to record the receipt of your application. Please make sure that you keep the Recorded or Special Delivery number.

We will return your passport(s) and other documents by Recorded Delivery. If you would like them to be returned by Special Delivery, you must provide a prepaid Special Delivery envelope big enough for the documents to be returned.

1100 AAPPPPLLYYIINNGG IINN PPEERRSSOONN

We offer a same-day service to people who apply on form EEA1 in person at our Public Enquiry Office (PEO) in Croydon.

AAppppooiinnttmmeennttss. To apply in person you must make an appoint-ment in advance with the Croydon PEO. Make an appointappoint-ment only when you have completed the correct form, and have all the documents and photographs.

If you attend the PEO without making a prior appointment, your application will not be accepted there. PEO appointments are limited to a certain number each day. If you cannot book one before your authorised stay in the UK is due to run out, you can make your application by post.

The address of the Croydon PEO is: PPuubblliicc EEnnqquuiirryy OOffffiiccee

LLuunnaarr HHoouussee 4400 WWeelllleesslleeyy RRooaadd CCrrooyyddoonn

CCRR99 22BBYY

The opening times from Monday to Friday inclusive are 8.00 -4.00. The telephone number is 00887700 660066 77776666.

For up-to-date information on opening times and services, please check the PEO pages on our website or phone the num-ber above.

1111 DDEECCIISSIIOONN TTIIMMEESS

We aim to decide applications as soon as possible. For informa-tion on the current processing times for postal applicainforma-tions for registration certificates on form EEA 1, see the “EEA/EU nation-als” page on our website.

1122 CCOONNTTAACCTTIINNGG UUSS AAFFTTEERR YYOOUU HHAAVVEE AAPPPPLLIIEEDD

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

TToo sseenndd uuss mmoorree iinnffoorrmmaattiioonn aabboouutt yyoouurr aapppplliiccaattiioonn, write to the address in part 9 and give the following details in your 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 or made in per-son

the Home Office reference number if you have one.

IIff yyoouu nneeeedd yyoouurr ppaassssppoorrtt bbeeccaauussee yyoouu hhaavvee ttoo ttrraavveell uurrggeennttllyy aanndd uunneexxppeecctteeddllyy, call 00887700 660066 77776666 and provide the person-al and other details listed immediately above.

1133 OOBBTTAAIINNIINNGG AANNOOTTHHEERR FFOORRMM

You can obtain application forms from the Application Forms Unit on 00887700 224411 00664455 or from our website.

1144 OOTTHHEERR TTEELLEEPPHHOONNEE EENNQQUUIIRRIIEESS

For enquiries other than obtaining an application form call 00887700 660066 77776666..

We also have the following freephone textphone number 00880000 3388 9988 2288 99..

1155 YYOOUURR RRIIGGHHTT TTOO RREESSIIDDEE IINN TTHHEE UUKK

EEA nationals have a right to reside in the UK if they are exercis-ing a Treaty right in one of the followexercis-ing categories:

• WWoorrkkeerr:: a person who is pursuing an effective and genuine 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 economically active.

(4)

The following nationals may exercise Treaty rights in the UK:

Austria Belgium

Bulgaria*** Cyprus** Czech Republic* Denmark

Estonia* Finland

France Germany

Greece Hungary*

Iceland Irish Republic

Italy Latvia* Liechtenstein Lithuania* Luxembourg Malta Netherlands Norway Poland* Portugal Romania*** Slovakia* Slovenia* Spain

Sweden Switzerland (but see part 1 of these notes) * The nationals of the countries marked with a single asterisk may have to register on the Worker Registration Scheme. For advice on how to obtain information about this, see part 16 below. If you have to register on the Scheme, you are not eligi-ble to apply for a registration certificate on the basis of employ-ment until you have worked legally in the UK for a continuous period of 12 months during which time you were not out of work for more than 30 days. You are not required to register on the Scheme if you are self-employed.

** A document issued by the Turkish Republic of Northern Cyprus does not establish that the person is an EEA national. Only a document issued by the Republic of Cyprus stating that the holder is a national of the Republic of Cyprus establishes that the person is an EEA national and accordingly entitled to free movement within the EU.

*** Bulgaria and Romania joined the European Union on 1 January 2007. Guidance and application forms for Bulgarian and Romanian nationals are to be found at

wwwwww..wwoorrkkiinnggiinntthheeuukk..ggoovv..uukk

1166 WWOORRKKEERR RREEGGIISSTTRRAATTIIOONN SSCCHHEEMMEE

If you are a national of the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia or Slovenia working in the UK you may have to register on this Scheme (this Scheme does not apply to self -employment). Further information about the Scheme is available at wwwwww..wwoorrkkiinnggiinntthheeuukk..ggoovv..uukk

1177 OOTTHHEERR EEEEAA FFOORRMMSS

The other EEA forms are as follows:

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

EEEEAA 33 for permanent residence applications by EEA nationals and their EEA or Swiss national family members and by Swiss nationals and their Swiss or EEA national family members EEEEAA 44 for permanent residence applications by non-EEA or non-Swiss national family members of an EEA national or Swiss national

FFMMRRSS for residence stamp applications by non-EEA national family members of persons required to register under the Worker Registration Scheme.

1188 CCHHOOOOSSIINNGG AANN IIMMMMIIGGRRAATTIIOONN AADDVVIISSEERR

If you engage an immigration adviser, take care when choos-ing one. The Office of the Immigration Services Commissioner (OISC) regulates immigration advisers. Their website at wwwwww..ooiisscc..ggoovv..uukk contains a list of authorised advisers. It also has links to websites for solicitors, barristers and legal execu-tives. If you have a complaint about an immigration adviser or need other information, the OISC contact details are:

OOffffiiccee ooff tthhee IImmmmiiggrraattiioonn SSeerrvviicceess CCoommmmiissssiioonneerr 55tthh FFlloooorr CCoouunnttiinngg HHoouussee 5533 TToooolleeyy SSttrreeeett LLoonnddoonn SSEE11 22QQNN Telephone: 00884455 000000 00004466

Alternatively the Law Society, which regulates solicitors in England and Wales, can help you find a solicitor. You can con-tact them on 00887700 660066 66557755 or visit their website at

wwwwww..llaawwssoocciieettyy..oorrgg..uukk

If you wish to complain about a solicitor you can contact the Law Society’s Consumer Complaints Service helpline on 00884455 660088 66556655 or write to them at:

TThhee LLaaww SSoocciieettyy VViiccttoorriiaa CCoouurrtt 88 DDoorrmmeerr PPllaaccee LLeeaammiinnggttoonn SSppaa W

Waarrwwiicckksshhiirree CCVV3322 55AAEE

1199 CCOOMMPPLLAAIINNTTSS AABBOOUUTT OOUURR SSEERRVVIICCEE

If you want advice on how to make a complaint about our serv-ice please telephone 00887700 224411 66552233 or visit our website. You may complain, in writing, to:

BBIIAA CCuussttoommeerr FFooccuuss TTeeaamm PPOO BBooxx 11338844

CCrrooyyddoonn CCRR99 33YYJJ

Or by email to: bbiiaa..ccuu@@hhoommeeooffffiiccee..ggssii..ggoovv..uukk

2200 DDAATTAA PPRROOTTEECCTTIIOONN NNOOTTIICCEE

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

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

(5)

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

SS EE CC TT II OO NN 11 -- AA PP PP LL II CC AA NN TT ’’ SS DD EE TT AA II LL SS

Name & address for returning documents and letters about your application if different from 11..1111 11..1144

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

11..1122 11..55

11..1133

Your title - please tick

Your date of birth If ootthheerr, what is your title?

Other Ms Miss Mrs 11..11 11..22

Day Month Year

Mr

Your gender - please tick

Male Female Do not use glue or

other sticky adhesive Attach two identical

photographs of you (the applicant)

here with a staple or paper clip Post code

EEEEAA11

RREEGGIISSTTRRAATTIIOONN

CCEERRTTIIFFIICCAATTEE

Date you last entered the UK

Day Month Year

(6)

SS EE CC TT II OO NN 22 -- EE EE AA OO RR SS W

W II SS SS NN AA TT II OO NN AA LL FF AA M

M II LL YY M

M EE M

M BB EE RR SS II NN CC LL UU DD EE DD

II NN YY OO UU RR AA PP PP LL II CC AA TT II OO NN

PPlleeaassee ggiivvee ddeettaaiillss bbeellooww ooff aannyy EEEEAA oorr 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.. NNoonn--EEEEAA oorr nnoonn--SSwwiissss nnaattiioonnaall ffaam m--iillyy mmeemmbbeerrss wwiisshhiinngg ttoo aappppllyy ffoorr aa rreessiiddeennccee ccaarrdd sshhoouulldd ccoommpplleettee ffoorrmm EEEEAA22..

IIff tthhee ffaammiillyy mmeemmbbeerr iiss yyoouurr cchhiilldd,, pplleeaassee pprroovviiddee ddooccuummeennttaarryy eevviiddeennccee ooff tthhee rreellaattiioonnsshhiipp ((iiee ffuullll bbiirrtthh cceerrttiiffiiccaattee)),, iiff yyoouurr ddeettaaiillss aarree 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 eevvii--ddeennccee ttoo ccoonnffiirrmm tthhee rreellaattiioonnsshhiipp ((iiee ffuullll bbiirrtthh,, mmaarrrriiaaggee oorr cciivviill ppaarrttnneerrsshhiipp cceerrttiiffiiccaatteess))..

Family member’s full name

Nationality

Date of birth Gender

-please tick

Day Month Year _Male _Female

Do not use glue or other sticky adhesive

Attach two identical photographs of the family member

here with a staple or paper clip

Home Office reference if they have one

Nationality

-please tick

Day Month Year Male Female

Nationality

-please tick

Day Month Year Male Female

Relationship to you

Home Office reference if they have one Relationship to you

(7)

SS EE CC TT II OO NN 33 -- EE M

M PP LL OO YY M

M EE NN TT

W

Woorrkkeerr -- ppeerrssoonn ppuurrssuuiinngg aann eeffffeeccttiivvee aanndd ggeennuuiinnee aaccttiivviittyy ffoorr rreemmuunneerraattiioonn aass aann eemmppllooyyeedd ppeerrssoonn.. IIff yyoouu aarree aappppllyyiinngg oonn tthhee bbaassiiss ooff bbeeiinngg aa wwoorrkkeerr,, aanndd yyoouu aarree nnoott aa nnaattiioonnaall wwhhoo hhaass bbeeeenn rreeqquuiirreedd ttoo rreeggiisstteerr uunnddeerr tthhee WWoorrkkeerr RReeggiissttrraattiioonn SScchheemmee ((iiee nnaattiioonnaallss ooff tthhee CCzzeecchh RReeppuubblliicc,, EEssttoonniiaa,, HHuunnggaarryy,, LLaattvviiaa,, LLiitthhuuaanniiaa,, PPoollaanndd,, SSlloovvaakkiiaa oorr SSlloovveenniiaa)),, yyoouu mmuusstt ccoommpplleettee tthhiiss sseeccttiioonn.. IIff yyoouu aarree aa nnaattiioonnaall wwhhoo hhaass rreeggiisstteerreedd uunnddeerr tthhee WWoorrkkeerr RReeggiissttrraattiioonn SScchheemmee,, pplleeaassee ggoo ttoo sseeccttiioonn 77..

Full name of employer (ie business or firm) 33 .. 22

Telephone number 33 .. 11

Post code

Business address and telephone number

33 .. 33 Address and telephone number if the address at which applicant is employed is different from the one in 33..22

33 .. 44 Type of business 33 .. 55

33 .. 77 33 .. 66

33 .. 88 33 .. 99

33 .. 11 00

Date employment started/will start Number of hours to be worked each week

Salary/wages received each month/week Expected duration of employment Position offered to, or held by, you

Post code Telephone number

Day Month Year

£ a month / week (delete as appropriate)

National insurance number if obtained

EEvviiddeennccee ooff EEmmppllooyymmeenntt: Please provide us with at least one of the following and tick relevant box(es): Contract(s) of employment

Most recent wage slips (at least one)

Letter(s) from employer confirming your employment

CCoommpplleettee tthhiiss sseeccttiioonn oonnllyy iiff yyoouu aarree aappppllyyiinngg aass aa wwoorrkkeerr -- bbuutt sseeee tthhee iinnffoorrmmaattiioonn bbeellooww..

EEmmppllooyyeerr’’ss DDeeccllaarraattiioonn

Employer’s stamp

(employee’s name) has been employed as a worker in this business

from _{in accordance with the details given above.}

Signature of employer

Day Month Year

(8)

SS EE CC TT II OO NN 44 -- SS EE LL FF EE M

M PP LL OO YY M

M EE NN TT

CCoommpplleettee tthhiiss sseeccttiioonn oonnllyy iiff yyoouu aarree aappppllyyiinngg aass aa sseellff--eemmppllooyyeedd ppeerrssoonn.. Name of business

Business address and telephone number

Signature of applicant _Date

YYoouurr bbuussiinneessss ddeettaaiillss 44 .. 11

EEvviiddeennccee ooff sseellff--eemmppllooyymmeenntt//bbuussiinneessss ttoo bbee pprroovviiddeedd::

44 .. 22

A lease on business premises Construction Industry Scheme (CIS) card (for the building trade)

Bank statement(s)

Invoices Inland Revenue self-assesment

forms Evidence of national insurancecontributions being paid. Telephone number

Post code

SS EE CC TT II OO NN 55 -- SS TT UU DD EE NN TT

55 .. 11 Name, address and telephone number of the educational establishment at which you are studying CCoommpplleettee tthhiiss sseeccttiioonn oonnllyy iiff yyoouu aarree aappppllyyiinngg aass aa ssttuuddeenntt..

Post code Telephone number

55 .. 22 Course title

55 .. 33 Date course of study starts/started Date course of study will end

Day Month Year Day Month Year

You are required to provide the following documentary evidence of your course of study and funds: - a school, college or university letter confirming enrolment and the completion date of the course, and - a bank statement or evidence of a grant or scholarship.

(9)

SS EE CC TT II OO NN 66 -- OO TT HH EE RR QQ UU AA LL II FF II EE DD PP EE RR SS OO NN SS

EEccoonnoommiiccaallllyy sseellff--ssuuffffiicciieenntt

Evidence of funds sufficient to maintain yourself and any family members included in this application during the time you intend to reside on this basis. These funds can come from the employment or self-employment of any of your family mem-bers residing in the UK with you. Documentary evidence of their employment or funds should be supplied.

RReettiirreedd

Evidence that you are in receipt of a pension. IInnccaappaacciittaatteedd

A doctor’s letter or medical report confirming incapacity. This should state if the incapacity is likely to be permanent.

CCoommpplleettee tthhiiss sseeccttiioonn oonnllyy iiff yyoouu aarree aappppllyyiinngg aass ssoommeeoonnee wwhhoo iiss eeccoonnoommiiccaallllyy sseellff--ssuuffffiicciieenntt,, rreettiirreedd oorr ppeerrmmaanneennttllyy iinnccaappaacciittaatteedd.. PPlleeaassee ttiicckk tthhee rreelleevvaanntt bbooxx bbeellooww ttoo sshhooww tthhee bbaassiiss oonn wwhhiicchh yyoouu aarree aappppllyyiinngg ffoorr aa rreeggiissttrraattiioonn cceerrttiiffiiccaattee aanndd pprroovviiddee tthhee ddooccuum meenn--ttaarryy eevviiddeennccee rreeqquueesstteedd..

SS EE CC TT II OO NN 77 -- W

W OO RR KK EE RR RR EE GG II SS TT RR AA TT II OO NN SS CC HH EE M

M EE

CCoommpplleettee tthhiiss sseeccttiioonn oonnllyy iiff yyoouu hhaavvee ccoommpplleetteedd 1122 mmoonntthhss’’ ccoonnttiinnuuoouuss llaawwffuull eemmppllooyymmeenntt iinn tthhee UUKK aafftteerr rreeggiisstteerriinngg uunnddeerr tthhee W

Woorrkkeerr RReeggiissttrraattiioonn SScchheemmee.. TThhee nnaattiioonnaallss wwhhoo mmaayy hhaavvee ttoo rreeggiisstteerr uunnddeerr tthhee SScchheemmee aarree tthhoossee ooff tthhee CCzzeecchh RReeppuubblliicc,, EEssttoonniiaa,, HHuunnggaarryy,, LLaattvviiaa,, LLiitthhuuaanniiaa,, PPoollaanndd,, SSlloovvaakkiiaa oorr SSlloovveenniiaa.. PPlleeaassee mmaakkee ssuurree yyoouu pprroovviiddee yyoouurr wwoorrkkeerr rreeggiissttrraattiioonn ccaarrdd aanndd aallll wwoorrkkeerr rreeggiissttrraattiioonn cceerrttiiffiiccaatteess..

77 .. 11 Date worker registration card issued Your worker registration card reference number

Day Month Year

Have you changed employment since you obtained your worker registration card

and worker registration certificate? Yes No

77 .. 22

77 .. 33 Please provide employment details/dates below. If you have worked for more than 2 employers in the last 12 months, please continue on a separate sheet.

Full name of employer (ie the business or firm) Address of employer

Date employment started Date ended

Post code

(10)

If yyeess, please provide all the dates (MM/YY) of unemployment subsequent to obtaining your worker registration card (contin-ue on a separate sheet if necessary).

Yes No

Have you been unemployed since you obtained your worker registration card? 77 .. 44

SS EE CC TT II OO NN 77 -- W

W OO RR KK EE RR RR EE GG II SS TT RR AA TT II OO NN SS CC HH EE M

M EE (( cc oo nn tt ii nn uu ee dd ))

Day Month Year _Day Month Year

From To

Month Year Month Year

Please provide us with the following documentation to prove that you have been lawfully engaged in employment in the UK while registered on the Worker Registration Scheme for a continuous 12 month period. You must provide the worker registra-tion card and all worker registraregistra-tion certificate(s), together with evidence from any of the other sources so long as, individual-ly or collectiveindividual-ly, they cover a continuous period of 12 months.

wage slips for the last 12 months; or

contract(s) of employment covering the last 12 months; or

letter(s) from your employer(s) confirming your employment over the last 12 months.

Worker registration card and all worker registration certificate(s), together with one of the following: 77 .. 55

Full name of employer (ie the business or firm) Address of employer

Date employment started Date ended

Post code

Month Year Month Year

(11)

88 .. 11 Do you or any family members included in this application have any criminal convictions in the

UK or any other country (including traffic offences) or any civil judgments made against you? YYeess NNoo

SS EE CC TT II OO NN 88 -- PP EE RR SS OO NN AA LL HH II SS TT OO RR YY

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

If you have answered yyeess to question 88..11 above please give details below for each criminal conviction and/or civil judgment, start-ing with the most recent one - but first see NNoottee 11 about criminal convictions. If you or any family members included in this applica-tion have received more than two convicapplica-tions and/or civil judgments, give details on a copy of this page and enclose it with this form.

Date of sentence/judgment Details of the sentence or civil judgment (give details on a separate sheet and enclose it with this form if

you need more space)

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

88 .. 22 Have you or any family members included in this application ever been charged in any country with a criminal offence for which you have not yet been tried in court?

YYeess NNoo 88 .. 33 In times of either peace or war have you or any family members included in this application

ever been 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)

88 .. 44

Have you or any family members included in this application ever been a member of, or given support 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 terror-ist acts or other serious criminal acts?

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

NNoottee 11 CCoonnvviiccttiioonnss ssppeenntt uunnddeerr tthhee RReehhaabbiilliittaattiioonn ooff OOffffeennddeerrss AAcctt 11997744 nneeeedd nnoott bbee ddiisscclloosseedd.. MMoorree iinnffoorrmmaattiioonn aabboouutt tthhee AAcctt iiss ggiivveenn ttoowwaarrddss tthhee eenndd ooff tthhiiss sseeccttiioonn..

88 .. 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

88 .. 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 a separate sheet and enclose it with this form if you need more space) Details of the sentence or civil judgment (give details on a separate sheet and enclose it with this form if

(12)

88 .. 77 Have you or any family members included in this application ever engaged in any other activities which might indicate that you may not be considered to be persons of good character?

If you have answered yyeess to question 88..22,, 88..33,, 88..44,, 88..55,, 88..66 or 88..77 above please give further details in the space provided below. If you need more space, continue on a separate sheet.

YYeess NNoo

DDEEFFIINNIITTIIOONNSS

For the purposes of answering questions 88..33 to 88..77,, the following information provides guidance on actions which may constitute war crimes, 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 Schedule 8 of the International Criminal Court Act 2001 at wwwwww..ooppssii..ggoovv..uukk//aaccttss//aaccttss22000011//2200001100001177..hhttmm or purchased from The Stationery Office (telephone 00887700 660000 55552222). 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 members included in the application.

W

Waarr ccrriimmeess

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 constitute 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. CCrriimmeess aaggaaiinnsstt hhuummaanniittyy

Acts committed at any time (not just during armed conflict) as part of a widespread or systematic attack, directed against any civil-ian population with knowledge of the attack. This would include offences such as murder, torture, rape, severe deprivation of liber-ty in violation 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 aaccttiivviittiieess

Any act committed, or the threat of action, designed to influence a government or intimidate the public and made for the purposes of advancing a political, religious or ideological cause and that involves serious violence against a person; that may endanger anoth-er panoth-erson’s life; creates a sanoth-erious risk to the health or safety of the public; involves sanoth-erious damage to propanoth-erty; is designed to sanoth-eri- seri-ously disrupt or interfere with an electronic system.

OOrrggaanniissaattiioonnss ccoonncceerrnneedd iinn tteerrrroorriissmm

An 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'. The length of the rehabilitation period depends on the sentence given. For a custodial (prison) sentence the rehabilitation period is decided by the original sentence, not the time served. Prison sentences of more than two and a half years can never become spent and should always be disclosed. Further information on rehabilitation periods can be found at Nacro's Resettlement Plus Helpline on 002200 77884400 66446644 or by obtaining a free copy of their leaflet on 002200 77884400 66442277.

(13)

SS EE CC TT II OO NN 99 -- DD OO CC UU M

M EE NN TT SS AA NN DD PP HH OO TT OO GG RR AA PP HH SS

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TTiicckk tthhee bbooxxeess nneexxtt ttoo tthhee rreelleevvaanntt iitteem

mss ttoo sshhooww tthhee ddooccuum

meennttss aanndd pphhoottooggrraapphhss yyoouu aarree pprroovviiddiinngg.. AAttttaacchh

aallll pphhoottooggrraapphhss ttoo tthhee ssppaacceess iinn sseeccttiioonnss 11 aanndd 22 aass iinnssttrruucctteedd tthheerree..

IIff sseeccttiioonn 33 ((eem

mppllooyym

meenntt)) hhaass bbeeeenn ccoom

mpplleetteedd,

contract(s) of employment, letter(s) from your employer(s) confirm-ing your employment or your most recent wage slips (at least one) should be provided. These should feature a full national insurance number rather than a temporary one.

wage slips for the last 12 months; or

contract(s) of employment covering the last 12 months.

letter(s) from your employer(s) confirming your employment over the last 12 months; or

IIff sseeccttiioonn 77 ((W

Woorrkkeerr RReeggiissttrraattiioonn SScchheem

mee)) hhaass bbeeeenn ccoom

mpplleetteedd

,

IIff sseeccttiioonn 55 ((ssttuuddeennttss)) hhaass bbeeeenn ccoom

mpplleetteedd,

a school, college or university letter confirming enrolment on a course of study and giving the completion date of the course; and evidence of funds available to you such as a bank statement or a doc-ument confirming the receipt of a grant or scholarship.

IIff sseeccttiioonn 66 ((eeccoonnoom

miiccaallllyy sseellff--ssuuffffiicciieenntt,, rreettiirreedd oorr iinnccaappaacciittaatteedd)) hhaass bbeeeenn ccoom

mpplleetteedd,

evidence of funds to show you are economically self-sufficient, eg a bank statement. If these funds come from a family mem-ber, evidence of their employment or funds should be supplied; or

evidence to show you are retired, eg document(s) confirming the receipt of a pension; or

IIff sseeccttiioonn 44 ((sseellff -- eem

mppllooyym

meenntt)) hhaass bbeeeenn ccoom

mpplleetteedd,

evidence to show you are self-employed, eg a lease on busi-ness premises, Construction Industry Scheme card, Inland Revenue self-assessment forms, bank statements, invoices or national Insurance contributions.

evidence to show you are permanently incapacitated, eg doctor’s letter or medical report confirming permanent incapacity, having previously been in employment or self employment.

TTwwoo rreecceenntt ppaassssppoorrtt--ssiizzee pphhoottooggrraapphhss ooff yyoouurrsseellff

with your name on the back of each photograph. Please see the guidance notes for information on what types of photograph are acceptable.

YYoouurr ccuurrrreenntt ppaassssppoorrtt oorr IIDD ccaarrdd..

If you last entered the UK on a previous passport or ID card, please also provide this document if you have it.

TThhee ccuurrrreenntt ppaassssppoorrtt((ss)) oorr IIDD ccaarrdd((ss)) ooff eeaacchh ffaam

miillyy m

meem

mbbeerr

included in section 2 for whom a registration certifi-cate is required.

TTwwoo rreecceenntt ppaassssppoorrtt--ssiizzee pphhoottooggrraapphhss ooff eeaacchh ffaam

miillyy m

meem

mbbeerr

included in section 2 for whom a registration cer-tificate is required with their name on the back of the photographs attached.

Your worker registration card and all worker registration certificate(s)

(14)

SS EE CC TT II OO NN 11 00 -- DD EE CC LL AA RR AA TT II OO NN

I hereby apply for a registration certificate for myself and any EEA or Swiss 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 also declare that the photographs submitted with this form are a true likeness of myself and any family

members included in the application form, 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

it may be disclosed to other government departments, agencies, local authorities, the police, foreign

gov-ernments and other bodies for immigration purposes or to enable them to perform their functions.

I understand that the documents provided in support of this application will be checked for authenticity.

False documents will be retained and may result in my application being refused and my case being

referred to the Border and Immigration Agency and other relevant authorities for the purposes of my

pros-ecution and subsequent removal from the United Kingdom.

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

II aam

m aawwaarree tthhaatt iitt iiss aann ooffffeennccee ttoo m

maakkee aa ssttaatteem

meenntt oorr rreepprreesseennttaattiioonn wwhhiicchh II kknnooww ttoo bbee ffaallssee oorr ddoo nnoott

bbeelliieevvee ttoo bbee ttrruuee,, oorr ttoo oobbttaaiinn oorr sseeeekk ttoo oobbttaaiinn aa rreeggiissttrraattiioonn cceerrttiiffiiccaattee bbyy m

meeaannss wwhhiicchh iinncclluuddee ddeecceeppttiioonn..

Date Signed

YYoouu m

muusstt nnooww rreeaadd tthhee ddeeccllaarraattiioonn bbeellooww aanndd ssiiggnn iitt.. IItt m

muusstt 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 m

maayy ssiiggnn..

(15)

Passports and/or ID cards Marriage or civil partnership cer-tificates Birth

certificates Other(please list

below)

DD OO CC UU M

M EE NN TT CC HH EE CC KK LL II SS TT

FF OO RR OO FF FF II CC II AA LL UU SS EE OO NN LL YY

Signed

_Date

AA PP PP LL II CC AA NN TT ’’ SS CC HH EE CC KK LL II SS TT

Is EEA1 the right form for you and is it valid for use?

See date on front page. Have you completed all relevant sections of the form asspecified?

TToo eennssuurree tthhaatt yyoouurr aapppplliiccaattiioonn iiss ccoom

mpplleettee,, pplleeaassee m

maakkee tthhee ffoolllloowwiinngg cchheecckkss bbeeffoorree ppoossttiinngg iitt.. TTiicckk eeaacchh bbooxx

tthhaatt iiss rreelleevvaanntt ttoo yyoouurr aapppplliiccaattiioonn..

PPlleeaassee ccoommpplleettee tthhiiss ppaarrtt ooff tthhee ffoorrmm.. IItt wwiillll hheellpp uuss ttoo mmaakkee ssuurree tthhaatt wwee hhaavvee rreecceeiivveedd tthhee ddooccuummeennttss yyoouu ssuupppplliieedd aanndd ttoo kkeeeepp aa rreeccoorrdd ooff tthheemm wwhhiillee tthheeyy aarree iinn oouurr ppoosssseessssiioonn.. TThhee lliisstt iiss aa ssttaannddaarrdd oonnee ccoovveerriinngg iimmppoorrttaanntt ddooccuummeennttss wwhhiicchh aarree ccoommmmoonn ttoo m

moosstt aapppplliiccaattiioonn ttyyppeess.. PPlleeaassee ssttaattee hhooww mmaannyy ooff eeaacchh ooff tthhee ffoolllloowwiinngg yyoouu hhaavvee pprroovviiddeedd.. Driving licences

Current passport(s) or ID card(s) including those for family mem-ber(s)

Photographs Worker registration card and all worker registra-tion certificate(s

)

If you are unable to send us any of the documents speci-fied in section 9 which are relevant to your application, have you given an explanation and said when you will be able to send them?

Have you, or your parent/guardian if you are under 18, signed and dated the declaration in section 10?

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

All other relevant doc-uments specified in section 9

EEuurrooppeeaann AApppplliiccaattiioonnss EEEEAA11 PP..OO.. BBooxx 330066 DDeepptt 4455 LLiivveerrppooooll LL22 00QQNN Passports and/or ID cards Marriage or civil partnership cer-tificates Birth

certificates Other(please list

below) Driving

licences