Application for a Document
Certifying Permanent Residence

EEA3

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.

Document
Certifying
Permanent
Residence

Version 06/2014

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. If you do not pay the fee, your application will be rejected. For …show more content…

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 Office’)

Cheque/bankers draft (payable to
‘Home Office’) - go to question A7

Visa/Mastercard/Amex - go to question A10

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.