Form EEA4 - UK Border Agency - the Home Office

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Please give details in the box below of which educational establishment they are attending. Youmust also provide evidence of this such as a letter from the school or college. Then go to section 7.4.17 Are you, or are you the family member of, someone who is either (please tick):A worker?Economically self-sufficient?Self-employed?Temporarily unable to work through illness or accident?Involuntarily unemployed?Unemployed and undertaking vocational training?4.18 If you answered yes to 4.17 please give details below. The information and evidence youshould provide is the same as in section 7 for details of the exercise of Treaty rights. Please alsostate the name, date of birth and nationality of your family member (if applicable). Continue on aseparate sheet if necessary and enclose it with this form.EEA4 Permanent Residence Card Version 06/2014 - page 18 of 38
Section 5 – Permanent Residence Due To Death Of EEA National Family MemberYou must complete this section if you are applying for a permanent residence card because yourEEA national family member who was working or self-employed has died but you have beenresident in the UK for less than 5 years. You must also complete section 7 to show how your EEAnational family member was exercising Treaty rights.5.1 Date your EEA national family member died D D M M Y Y Y Y5.2 Were you living with your EEA national family memberimmediately before they died?5.3 Had your EEA national family member lived in the UKfor at least the 2 years immediately before they died?5.4 Was your EEA national family member’s death due to anaccident at work or an occupational disease?YesYesYesNoNoNoEEA4 Permanent Residence Card Version 06/2014 - page 19 of 38
Page 4: Page left deliberately blankEEA4 Pe
Page 7 and 8: Please note that we always use the
Page 9 and 10: The following nationals may exercis
Page 12 and 13: 1.9 Place of birth - town or city a
Page 14 and 15: 2.13 Family member’s full name2.1
Page 16: Section 4 - Retained Right Of Resid
Page 21 and 22: About you6.6 How are you related to
Page 23 and 24: Rented by you/the BritishcitizenPro
Page 26 and 27: Section 7 - Details Of The Exercise
Page 28 and 29: Section 8 - Time Spent Outside The
Page 30 and 31: Date sentenced D D M M Y Y Y YIf yo
Page 32 and 33: Section 10 - PhotographsYou must pr
Page 34 and 35: For time spent seeking work: this c
Page 36 and 37: Section 12 - DeclarationPlease read
Page 38: Final ChecklistTo ensure that your

Form EEA4 - UK Border Agency - the Home Office

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