Form EEA4 - UK Border Agency - the Home Office

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Residence in the EEA state6.9 Please give details of where you, the British citizen, and your family lived while the Britishcitizen was working or self-employed in the EEA state named above. Start with the most recentaddress. Continue on a separate sheet if necessary.Please also provide relevant evidence, such as tenancy agreements, leases, mortgagestatements, etc. If the accommodation was provided by an employer, friend or relative, pleaseprovide a letter from them confirming this, together with proof that you/the British citizen lived atthat address (e.g. utility bills in your/their name).AddressWho lived there (you,the British citizen, anyother family members)Dates livedthere (from/to)Ownership of property (pleasetick for each address)Owned by you/the BritishcitizenRented by you/the BritishcitizenProvided by employer/friend/relativeOther - please specifyOwned by you/the BritishcitizenRented by you/the BritishcitizenProvided by employer/friend/relativeOther - please specifyOwned by you/the BritishcitizenEEA4 Permanent Residence Card Version 06/2014 - page 22 of 38
Rented by you/the BritishcitizenProvided by employer/friend/relativeOther - please specify6.10 Details of any absences by you or the British citizen from the EEA Member State while you/they were resident there. Continue on a separate sheet if necessary.Who was absent from the EEAstate (you, the British citizen,or any other family membersincluded in the application)Country or countriesvisitedDate ofdeparturefrom theEEA stateDate ofreturn tothe EEAstateNumber ofdays6.11 Date on which the British citizen returned to live in the UK:day month year6.12 If you or any of your family members lived with the British citizen in the EEA state, pleaseconfirm the date you/they returned to live in the UK. If not applicable, write ‘N/A’.You:day month yearOther family members:EEA4 Permanent Residence Card Version 06/2014 - page 23 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 19 and 20: Section 5 - Permanent Residence Due
Page 21: About you6.6 How are you related to
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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