Form EU1A (2017-06) - Page 1 of 21 DEPARTMENT OF JUSTICE AND EQUALITY IRISH NATURALISATION & IMMIGRATION SERVICE FORM EU1A FOR OFFICE USE ONLY Application to be treated as a permitted family member of a Union citizen 2017-06 This form is to be completed by each non-EEA national applying to be treated as a permitted family member of a European Union citizen under the European Communities (Free Movement of Persons) Regulations 2015 (the “Regulations”). This form must be completed in block letters. Where indicated, please place a tick ( ) in the appropriate box. Before an application for a residence card is accepted, an examination of whether the applicant should be treated as a permitted family member of a Union citizen will be carried out under Regulation 5 of the Regulations. Please follow the guidance notes in the Form EU1A Explanatory Leaflet carefully and complete all questions as indicated. o All applicants should complete Sections 1, 2, 3, 7, 8, and 9. o Applicants applying as the partner of an EU citizen should complete Section 4. o Applicants applying as the dependent or member of the household of an EU citizen should complete Section 5. o Applicants applying on serious medical grounds requiring the personal care of an EU citizen should complete Section 6. o Where prompted, supplementary information regarding residence, activities, or other persons, may be provided on Annex A, B, or C respectively, available on the website at http://www.inis.gov.ie/en/INIS/Pages/EU Treaty Rights/. You must fill out a separate application form for each non-EEA national seeking to be treated as a permitted family member, including each minor child, and submit separate documents for each application. Certain documents are required to be enclosed with this form. Please refer to the Form EU1A Explanatory Leaflet for details. Submitted documents must be itemised, with a clear explanation of the relevance of each individual document. Your application may be refused if you submit a false document or information, or if you withhold relevant information. It may harm the credibility of your application if you supply a false document. A decision will be made on your application based on the information contained in this application form and the supporting documents you submit with this form. No further information or documentation will be requested. Section 1 Applicant details 1.1 Basis of permitted family relationship of applicant to EU citizen () Partner in a durable relationship Where the relationship is long-lasting but you are not a spouse or civil partner Dependent Where you were a dependent of the EU citizen in the country from which you have come Member of household Where you were a member of the EU citizen’s household in the country from which you have come Serious medical grounds Where you strictly require the personal care of the Union citizen for serious medical reasons 1.2 If dependent, member of household or serious medical grounds, indicate family relationship () A. Sister/brother Aunt/uncle Niece/nephew Cousin Other: B. of an EU citizen of the spouse or civil partner of an EU citizen 1.3 Surname / Family name (as in passport) 1.4 Forename(s) (as in passport) 1.5 Other name(s) (maiden name, name at birth, any other names by which you are or have been known) artment of Justi ce, Equality and Law Ref
Transcript
Form EU1A (2017-06) - Page 1 of 21
DEPARTMENT OF JUSTICE AND EQUALITY
IRISH NATURALISATION & IMMIGRATION SERVICE
FORM EU1A
FOR OFFICE USE ONLY
Application to be treated as a permitted
family member of a Union citizen
2017-06
This form is to be completed by each non-EEA national applying to be treated as a permitted family member of a European Union citizen under the European Communities (Free Movement of Persons) Regulations 2015 (the “Regulations”).
This form must be completed in block letters. Where indicated, please place a tick ( ) in the appropriate box.
Before an application for a residence card is accepted, an examination of whether the applicant should be treated as a permitted family member of a Union citizen will be carried out under Regulation 5 of the Regulations.
Please follow the guidance notes in the Form EU1A Explanatory Leaflet carefully and complete all questions as indicated.
o All applicants should complete Sections 1, 2, 3, 7, 8, and 9.
o Applicants applying as the partner of an EU citizen should complete Section 4.
o Applicants applying as the dependent or member of the household of an EU citizen should complete Section 5.
o Applicants applying on serious medical grounds requiring the personal care of an EU citizen should complete Section 6.
o Where prompted, supplementary information regarding residence, activities, or other persons, may be provided on Annex A, B, or C respectively, available on the website at http://www.inis.gov.ie/en/INIS/Pages/EU Treaty Rights/.
You must fill out a separate application form for each non-EEA national seeking to be treated as a permitted family member, including each minor child, and submit separate documents for each application.
Certain documents are required to be enclosed with this form. Please refer to the Form EU1A Explanatory Leaflet for details. Submitted documents must be itemised, with a clear explanation of the relevance of each individual document.
Your application may be refused if you submit a false document or information, or if you withhold relevant information. It may harm the credibility of your application if you supply a false document.
A decision will be made on your application based on the information contained in this application form and the supporting documents you submit with this form. No further information or documentation will be requested.
Section 1 Applicant details
1.1 Basis of permitted family relationship of applicant to EU citizen ()
Partner in a durable relationship Where the relationship is long-lasting but you are not a spouse or civil partner
Dependent Where you were a dependent of the EU citizen in the country from which you have come
Member of household Where you were a member of the EU citizen’s household in the country from which you have come
Serious medical grounds Where you strictly require the personal care of the Union citizen for serious medical reasons
1.2 If dependent, member of household or serious medical grounds, indicate family relationship ()
A. Sister/brother
Aunt/uncle
Niece/nephew
Cousin
Other:
B. of an EU citizen
of the spouse or civil partner of an EU citizen
1.3 Surname / Family name (as in passport)
1.4 Forename(s) (as in passport)
1.5 Other name(s) (maiden name, name at birth, any other names by which you are or have been known)
Department of Justice,Equality and Law ReformIrish Naturalisation &ImmigrationService
1.6 Date of birth 1.7 Gender () 1.8 INIS Person ID Number (if known)
D D M M Y Y Y Y
—
Day Month Year Male Female Other
1.9 Nationality
1.10 Do you hold, or have you ever held, any other nationality or nationalities? ()
Yes (give details below)
No
1.11 Current residential address in Ireland
1.12 Address Eircode 1.13 Contact telephone number of applicant
1.14 Email address
1.15 PPS number (if applicable) 1.16 Old Department reference number (if applicable)
6 9
Section 1A | Relationship status of applicant and children of applicant
1.17 Marital status ()
Single
Married
Civil partner
Divorced
Widowed
1.18 If you are married or in a partnership, provide the details of your spouse or partner on Annex C and enclose it with this application form.
I have filled out and enclosed Annex C for my spouse/partner
1.19 If you have previously been married or in a civil partnership which has since ended, please provide details below. You should supply any civil certificates as evidence of divorce, annulment, dissolution or death as appropriate.
1.20 Do you have children? ()
Yes
No If yes, how many?
1.21 If you have children, you must enclose details of each child on Annex C and enclose it with this application form. Use multiple sheets if necessary.
I have filled out and enclosed Annex C for each child ()
1.26 Date of arrival in Ireland 1.27 Point of entry to Ireland ()
D D M M Y Y Y Y
Airport
Seaport
Land Border
1.28 Place of arrival in Ireland (port of entry)
1.29 Status on arrival in Ireland ()
Asylum-seeker
Family member of EU citizen
Employment Permit or Green Card Permit
Student
Visitor
Entry without permission
Other:
1.30 Have you previously resided in Ireland?
Yes (give details below)
No
1.31 Do you have any other family members resident in Ireland?
Yes (give details below)
No
1.32 Do you have any family members resident in other EU Member States?
Yes (give details below)
No
1.33 If you answered “yes” to 1.32, do those family members intend to join you in Ireland?
Yes
No
1.34 Have you ever previously visited Ireland?
Yes (give details below)
No
1.35 Do you currently have any other applications with INIS on which you are awaiting a decision?
Yes (give details below)
No
Type of application Date submitted Application ID
D D M M Y Y Y Y – –
D D M M Y Y Y Y – –
D D M M Y Y Y Y – –
Form EU1A (2017-06) - Page 4 of 21
1.36 Have you travelled outside your country of birth in the last 10 years?
Yes (give details below)
No
Date Destination Purpose Duration of visit/stay
1.37 Have you previously applied for permission to visit or reside in another EU Member State? If yes, you should provide evidence of entry and exit as applicable.
Yes (give details below)
No
Type of permission/visa Country Outcome Duration of visit/stay
1.38 Have you previously applied for permission to visit or reside in any other country? If yes, you should provide evidence of entry and exit as applicable.
Yes (give details below)
No
Type of permission/visa Country Outcome Duration of visit/stay
1.39 Have you ever been denied permission to enter or remain in another EU Member State? If yes, provide details of the application made, the decision, and the reasons for the decision.
Yes (give details below)
No
Form EU1A (2017-06) - Page 5 of 21
1.40 Have you ever been denied permission to enter or remain in any other country? If yes, provide details of the application made, the decision, and the reasons for the decision.
Yes (give details below)
No
1.41 Have you been convicted of any criminal offence in Ireland or any other country?
Yes (give details below)
No
1.42 Are there any charges pending against you in Ireland or any other country?
Yes (give details below)
No
1.43 Have you ever been deported from Ireland?
Yes (give details below)
No
1.44 Are you currently subject to a Deportation Order or Transfer Order made in Ireland?
Yes (give details below)
No
1.45 Have you ever been subject to a deportation, exclusion, or removal order (voluntary or required) in any other country?
Yes (give details below)
No
Section 2 EU citizen details
2.1 Surname / Family name (as in passport)
2.2 Forename(s) (as in passport)
2.3 Other name(s) (maiden name, name at birth, any other names by which you are or have been known)
2.4 Date of birth 2.5 Gender () 2.6 INIS Person ID Number (if known)
D D M M Y Y Y Y
—
Day Month Year Male Female Other
Form EU1A (2017-06) - Page 6 of 21
2.7 Nationality
2.8 Place and country of birth
2.9 Does the EU citizen hold, or have they ever held, any other nationality or nationalities?
Yes (give details below)
No
Nationality Date held from Date held to
2.10 Current residential address in Ireland
2.11 Address Eircode 2.12 Contact telephone number of EU citizen
2.13 Email address
2.14 PPS number (if applicable) 2.15 Old Department Reference number (if applicable)
6 9
2.16 Passport or National Identity Card number 2.17 Date of arrival in Ireland
D D M M Y Y Y Y
2.18 Why is the EU citizen moving to Ireland?
2.19 Has the EU citizen previously visited or resided in Ireland? If yes, please specify: dates, reasons for visits or residence, durations of visits or residence, reasons for leaving, and destination after departure from Ireland.
Yes (give details below)
No
Form EU1A (2017-06) - Page 7 of 21
Section 2A | Activity of the EU citizen in the country from which they have come
2.20 Type of activity ()
Employment
Self-employment
Study
Involuntary unemployment
Residing with sufficient resources
2.21 Name of EU citizen’s previous employer, business or college
2.22 Address of employer, business or college
2.23 Total duration of activity 2.23 End date of employment (if applicable)
Years Months D D M M Y Y Y Y
2.24 Circumstances of unemployment (e.g. voluntary or involuntary) or cessation of activity
2.25 If studying or residing with sufficient resources, details of financial resources:
2.26 Annual income from activity 2.27 If self-employed, is the business still operating?
€
Yes
No
2.28 Has the EU citizen conferred residence status under EU Treaty Rights to any other individual in Ireland or any other EU Member State?
Yes (give details below)
No
Section 2B | Relationship status of EU citizen and children of EU citizen
2.29 Marital status ()
Single
Married
Civil partner
Divorced
Widowed
2.30 If married or in a partnership, please provide the details of spouse or partner on Annex C and enclose it with this application form.
I have filled out and enclosed Annex C for the EU citizen’s spouse/partner
2.31 If the EU citizen has previously been married or in a civil partnership which has since ended, please provide details below. You should supply any civil certificates as evidence of divorce, annulment, dissolution or death as appropriate.
2.33 If the EU citizen has children, you must enclose details of each child on Annex C and enclose it with this application form. Use multiple sheets if necessary.
I have filled out and enclosed Annex C for each child ()
2.34 If children are not residing with the EU citizen, are financial maintenance arrangements in place? If yes, please specify whether the arrangements are approved or directed by a relevant court, and give details.
Yes (give details below)
No
2.35 Are there any formal or informal custody or right of access agreements in relation to children of the EU citizen? If yes, you should enclose a copy of the court order or written agreement as applicable and give details below.
Yes, formal (details below)
Yes, informal (details below)
No
Section 3 Current activity of the EU citizen in the State
3.1 Type of activity ()
(A) Employment (B)
Self-employment (C)
Involuntary unemployment
(D) Residing with sufficient resources
Please fill out Parts (A - D) below as applicable to the current activity of the EU citizen in the State.
NOTE: It is important to provide accurate contact details for employer/college as they may be contacted to verify the information provided.
(A) Employment
3.2 Name of employer
3.3 Address of workplace
3.4 Workplace address Eircode 3.5 Employer’s contact telephone number
3.6 Employer’s email address
3.7 Monthly net income (after tax) 3.8 Average hours worked weekly 3.9 Type of contract ()
€
Permanent
Temporary
3.10 Date of commencement of employment 3.11 Job title
3.14 Position or role of EU citizen in the business
3.15 Monthly income of EU citizen 3.16 Average hours worked weekly
€
3.17 Address of business
3.18 Business address Eircode 3.19 Business telephone number
3.20 Date business commenced trading 3.21 Business monthly operating costs
D D M M Y Y Y Y €
3.22 Number of employees 3.23 Are all employees registered with the Revenue Commissioner?
Yes
No
(C) Involuntary unemployment
3.24 Name of last previous employer
3.25 Address of last previous employer
3.26 Employer address Eircode 3.27 Last previous employer’s contact telephone number
3.28 Total duration of previous employment in the State 3.29 Date of redundancy
Years
Months D D M M Y Y Y Y
3.30 Details of social assistance received by EU citizen
3.31 Monthly income of EU citizen 3.32 Registered as a jobseeker with D/Social Protection ()
€
Yes
No
Form EU1A (2017-06) - Page 10 of 21
(D) Residing with sufficient resources
3.33 Source of financial resources
3.34 Frequency of payments received (if applicable) 3.35 Average payment amount
Every Months
Weeks
Days €
3.36 Details of financial resources available to EU citizen
3.37 Monthly income of EU citizen 3.38 Comprehensive sickness insurance ()
€
Yes
No
Section 4 Partners
Complete this section if you are in a durable (lasting) relationship with the EU citizen but you are not their spouse or civil partner.
4.1 When did you first meet the EU citizen?
4.2 Where did you first meet the EU citizen?
4.3 Are you and the EU citizen related outside of your partnership? ()
Yes (give details below)
No
4.4 When did your relationship begin? 4.5 When did you start living together?
D D M M Y Y Y Y D D M M Y Y Y Y
4.6 Were you in a relationship when you started living together? ()
4.7 Have you ever lived with the EU citizen outside of
Ireland? ()
Yes
No
Yes
No
4.8 Have you lived with the EU citizen at an address other than the address given in Section 2 of this form during the 2 years immediately preceding this application? ()
Yes
No
4.9 Do you intend to live with the EU citizen permanently in the State? ()
Yes
No (give reasons below)
4.10 If you have answered “yes” to 4.7 or 4.8 above you must provide all previous addresses on Annex A, which can be downloaded from the INIS website, and enclose it with this application form. Use multiple sheets if necessary.
I have filled out and enclosed Annex A ()
Form EU1A (2017-06) - Page 11 of 21
4.11 Do you and the EU citizen have any children together? ()
Yes
No If yes, how many?
4.12 Do you have any children of whom the EU citizen is not the parent (i.e. from a previous or other relationship)? ()
Yes
No If yes, how many?
4.13 Does the EU citizen have any children living in Ireland of whom you are not the parent? ()
Yes
No If yes, how many?
4.14 If you have answered “yes” to 4.11, 4.12 or 4.13 above and any of those children are under the age of 18, you must enclose details of each child on Annex C and enclose it with this application form. Use multiple sheets if necessary.
I have filled out and enclosed Annex C for each child ()
4.15 Have you at any time submitted a Notification of Intention to Marry to a Registrar of the Civil Registration Service? If yes, please provide the date and venue of the intended marriage and supply documentation in support of same.
Yes (give details below)
No
4.16 If you answered “yes” to 4.15, have any objections to your proposed marriage been raised by the Civil Registration Service? If yes, please provide the reasons for the objection and any related documentation.
Yes (give reasons below)
No
Section 5 Dependents and members of the household
Complete this section if you are a relative of the EU citizen, or of their spouse or civil partner, and: you were dependent on the EU citizen or were a member of the EU citizen’s household before you came to Ireland,
in the country from which you have come, and since entering Ireland, you have continued to be dependent on the EU citizen or be a member of the EU citizen’s
household.
Section 5A | Before coming to Ireland
5.1 Were you dependent on the EU citizen before you came to Ireland? ()
5.2 Were you a member of the household of the EU citizen
before you came to Ireland? ()
Yes
No
Yes
No
5.3 Give details below of any other source of income or capital you had before coming to Ireland. This could include income from employment or self-employment, a pension, social security payments, income from rental property, savings, investments or any other income. You should provide corresponding documentary evidence with your application.
5.4 Did you receive money from the EU citizen before coming to Ireland? If yes, please specify how much, how often and for how long. You should provide corresponding documentary evidence with your application.
Yes (give details below)
No
5.5 Did you receive money from any other relative or friend before coming to Ireland? If yes, please specify how much, how often and for how long. You should provide corresponding documentary evidence with your application.
Yes (give details below)
No
5.6 Did you live with the EU citizen at the same address immediately before you came to Ireland? ()
Yes
No
5.7 Please provide dates of residence at address
From D D M M Y Y Y Y To D D M M Y Y Y Y
5.8 In the country from which you have come, at the address where you resided, did the EU citizen: ()
Own the property outright either individually of jointly
Own the property with a mortgage either individually or jointly
Rent the property
Reside rent free
5.9 What was your address in your home country before you came to Ireland?
5.10 If the property was jointly-owned, please provide the names of all interested parties:
5.11 If the property was rented, please indicate the type of landlord () and provide contact details below:
Private landlord
County council or local authority
Voluntary cooperative housing body
5.12 If the property was rented, please provide the names of all named tenants:
Form EU1A (2017-06) - Page 13 of 21
5.13 Who else lived at the property and what was the relationship between you and the EU citizen and each resident?
Name Duration of residence Relationship to applicant Relationship to EU citizen
5.14 How many rooms were there at this address?
Bedrooms: Common rooms (e.g. bathrooms, kitchen, sitting rooms):
5.15 Please complete the table below with details of your outgoings and expenditure before you came to Ireland. This could include rent/mortgage payments, gas, electricity, or water bills, medical bills, insurance. If the EU citizen or another relative or a friend helped you with these, please give details in the third column. You should provide corresponding documentary evidence with your application.
Item Amount Contributor(s)
Section 5B | Since coming to Ireland
5.16 When did the EU citizen enter Ireland? 5.17 When did you enter Ireland?
D D M M Y Y Y Y D D M M Y Y Y Y
5.18 If you did not enter Ireland at the same time as the EU citizen, please explain why below:
5.19 Are you currently dependent on the EU citizen since coming to Ireland? ()
5.20 Are you currently a member of the household of the
EU citizen in Ireland? ()
Yes
No
Yes
No
Form EU1A (2017-06) - Page 14 of 21
5.21 Do you regularly receive money from the EU citizen? If yes, please specify how much, how often and for how long. You should provide corresponding documentary evidence (e.g. bank statements) with your application.
Yes (give details below)
No
5.22 Do you regularly receive money from any other relative or friend? If yes, please specify how much, how often and for how long. You should provide corresponding documentary evidence with your application.
Yes (give details below)
No
5.23 Please give details in the table below of any other regular source of income or capital you have, from Ireland or otherwise. This could include income from employment or self-employment, a company or state pension, state benefits, income from rental property, savings, investments, or any other income. You should provide corresponding documentary evidence with your application.
Item Amount/Value How often
5.24 Do you currently live with the EU citizen? ()
Yes
No
5.25 At the address where you reside, does the EU citizen: ()
Own the property outright either individually or jointly
Own the property with a mortgage either individually or jointly
Rent the property
Reside rent free
5.26 If the property is jointly-owned, please provide the names of all interested parties:
Form EU1A (2017-06) - Page 15 of 21
5.27 If the property is rented, please indicate the type of landlord () and provide contact details below:
Private landlord
County council or local authority
Voluntary cooperative housing body
5.28 If the property is rented, please provide the names of all named tenants:
5.29 Who else lives at the property and what is the relationship between you and the EU citizen and each resident?
Name Duration of residence Relationship to applicant Relationship to EU citizen
5.30 How many rooms are there at this address?
Bedrooms: Common rooms (e.g. bathrooms, kitchen, sitting rooms):
5.31 Please complete the table below with details of your regular outgoings and expenditure in Ireland. This could include things like rent/mortgage payments, gas, electricity, or water bills, medical bills, insurance, etc. If the EU citizen or another relative or a friend helps you with these, please give details in the third column. You should provide corresponding documentary evidence with your application.
Item Amount Contributor(s)
Form EU1A (2017-06) - Page 16 of 21
Section 5C | Other information
5.32 Please give any further information about your financial circumstances before or after coming to Ireland.
5.33 Please give details of any emotional or physical support you receive, or have received, from the EU citizen. You should provide corresponding documentary evidence with your application.
5.34 Please give details of any family in your home country.
5.35 Please give details of any compelling or compassionate circumstances which would make it difficult for you to live in your home country without the EU citizen. You should provide corresponding documentary evidence.
5.36 Should your application be refused, and it is considered that such a refusal would prevent the EU citizen from exercising EU Treaty Rights in the State, please explain why this is the case and provide documentary evidence supporting your claim.
Form EU1A (2017-06) - Page 17 of 21
Section 6 Serious medical grounds
Complete this section if you are a relative of the EU citizen, or of their spouse or civil partner, and you strictly require the personal care of the EU citizen (or of their spouse or civil partner) on serious health grounds.
6.1 What is the nature of your health condition? Please include a report from a medical consultant with your application.
6.2 How long have you had this health condition and how long is it expected to last? These details should be included in the medical report provided for 6.1 above.
6.3 Do you require help or support to undertake daily tasks, such as washing and dressing yourself, or preparing food for yourself? You should provide corresponding documentary evidence.
Yes (give details below)
No
6.4 Who currently provides you with the majority of your care? You should provide corresponding documentary evidence.
6.5 If the person indicated in question 6.4 above is not the EU citizen named in Section 2, please provide their details on Annex C and enclose it with this application form. If you have more than one carer, you should use multiple sheets.
I have filled out and enclosed Annex C
6.6 Please describe the care they provide you with:
6.7 How frequently do you require care? ()
Daily
Every few days
Weekly
Monthly
6.8 Do you receive any care from any other person or organisation (e.g. social services) not mentioned above?
Yes (give details below)
No
6.9 Before the person specified in 6.4 above started caring for you, did any other person or organisation provide care?
6.10 If you answered “yes” to 6.9 above, please explain why the previous caring arrangement stopped (if it stopped):
6.11 Are you currently doing any paid or unpaid work in Ireland (employed or self-employed)?
Yes (give details below)
No
6.12 If you wish to provide any further information about your circumstances, please use the box below.
Section 7 Document Checklist
Please ensure that all required documents are submitted with this application form. A decision will be made on your application based on the information contained in this application form and the supporting documents you submit with this form. No further information or documentation will be requested. Please see the Form EU1A Explanatory Leaflet for examples of documents that may be submitted.
Please provide photocopies of the documents requested below. Identity documents and civil certificates should be photocopied in colour and photocopies should include all pages (including blank passport pages).
Evidence of identity
Passport of applicant
Passport or National Identity Card of EU citizen
Two passport-size photos of applicant
Two passport-size photos of EU citizen
Evidence of relationship of applicant to EU citizen
Please provide supporting evidence of your family relationship as specified in sections 1.1 and 1.2. A detailed description of these documents should also be included in Section 8.
Evidence of family relationship to EU citizen (for Sections 5, 6) – e.g. birth or adoption certificates, marriage/civil partnership certificates
Evidence of durable relationship (for Section 4) – e.g. evidence of living together (such as utility bills, mortgage/tenancy agreements etc.); birth certificates of children; evidence that any previous marriage/civil partnership has legally ended (e.g. divorce decree, final dissolution order etc.)
Evidence of dependency or household membership (for Section 5) – e.g. money transfer receipts and corresponding bank statements, evidence of accommodation.
Evidence of strictly requiring personal care (for Section 6) – e.g. detailed medical report from a medical consultant registered with the Irish Medical Council
Previous immigration or residence documents for applicant (e.g. registration certificate, residence card, residence permit, previous passports)
Form EU1A (2017-06) - Page 19 of 21
Evidence of residence in Ireland
If renting
Letter from landlord/agency, rental contract or tenancy agreement
Letters of Registration of Tenancy from the Residential Tenancies Board
Utility bills in the names of both the applicant and the EU citizen
If home-owning
Letter from mortgage provider, local authority, or County Council
Title or deeds (as applicable)
Utility bills in the names of both the applicant and the EU citizen
Evidence of current activity of EU citizen in the State
Please provide supporting documents for the current activity as per Section 3, Parts A–D.
(A) Employment
Current letter from employer with full contact details for employer
Letter from employer or signed contract of employment setting out terms of employment
Two recent payslips
Most recent P60 or Tax Credit Certificate
(B) Self-employment
Agreed Tax Assessment from the Revenue Commissioner for the last financial year (if applicable)
Letter of Registration for Self-Assessment (Income Tax) from the Revenue Commissioner
Certificate from the Companies Registration Office (if applicable)
Receipts issued for sales or services in the last six months
Bank statements of the business for the last six months
(C) Involuntary unemployment
Letter from Department of Social Protection with details of benefit claims
Letter from previous employer outlining circumstances of redundancy
P60s for prior two years of employment
P45 from last employment
(D) Residing with sufficient resources
Evidence of financial resources and corresponding bank statements
Letter from Department of Social Protection with details of any benefit claims (or stating that there are no claims)
Letter from private medical insurance provider (for EU citizen and any dependents)
Evidence of the previous activities of the EU citizen in the country from which they have come
Please provide supporting documents for the previous activities of the EU citizen as per Section 2B. A detailed description of these documents should also be included in Section 8.
Evidence of employment – e.g. letter from employer, employment contract, tax documents, pay slips
Evidence of self-employment – e.g. tax return or tax registration letter, receipts for services delivered and corresponding bank statements showing income, registration documents for company or business
Evidence of study – e.g. enrolment letters or graduation certificates, documents relating to source of income, bank statements showing available funds or income, policy statement for private medical insurance
Evidence of involuntary unemployment – e.g. letter of redundancy, letters or forms from social welfare authority, evidence of having sought employment
Evidence of sufficient resources – e.g. documents relating to source of income, bank statements showing available funds or income, policy statement for private medical insurance
Form EU1A (2017-06) - Page 20 of 21
Section 8 Document list
List of documents enclosed. Each document must be numbered and described below.
# Description Quantity
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Form EU1A (2017-06) - Page 21 of 21
Section 9 Declarations
Applicant
This declaration should be signed and dated by the applicant, or by the parent or guardian of an applicant under the age of 18.
I hereby apply to be treated as a permitted family member of a Union citizen. The information I have given 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 me. I confirm that if, before my application is decided, there is a material change in my circumstances or new information relevant to this application becomes available, I will inform the EU Treaty Rights Unit of the Department of Justice and Equality in writing immediately. I understand that any false or misleading information or fraudulent supporting documentation submitted will result in the refusal of this application.
I understand that, under Section 8 of the Immigration Act 2003 and Regulation 26 of the European Communities (Free Movement of Persons) Regulations 2015, the data in this application may be disclosed to other Irish Government Departments as well as to public authorities of the Member States of the European Union and European Economic Area (EEA) for purposes connected to this application. I consent to the EU Treaty Rights Unit making enquiries to confirm any of the details or documents provided by me in this application, including my participation in an interview process.
I am aware that a person who asserts an entitlement to any rights on the basis of information which he or she knows to be false or misleading in a material particular shall be guilty of an offence and shall be liable, on summary conviction or conviction on indictment, to a fine up to € 100,000 or term of imprisonment of up to two years or both, as set out in Regulation 30 of the European Communities (Free Movement of Persons) Regulations 2015.
Signed by applicant Date
D D M M Y Y Y Y
Day Month Year
EU Citizen
This declaration should be signed and dated by the European Union, EEA or Swiss citizen.
The information 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 of a true likeness of me. I confirm that if, before the application is decided, there is a material change in my circumstances or new information relevant to this application becomes available, I will inform the EU Treaty Rights Unit of the Department of Justice and Equality in writing immediately. I understand that any false or misleading information or fraudulent supporting documentation submitted will result in the refusal of this application.
I understand that, under Section 8 of the Immigration Act 2003 and Regulation 26 of the European Communities (Free Movement of Persons) Regulations 2015, the data in this application may be disclosed to other Irish Government Departments as well as to public authorities of the Member States of the European Union and European Economic Area (EEA) for purposes connected to this application. I consent to the EU Treaty Rights Unit making enquiries to confirm any of the details or documents provided by me in this application, including my participation in an interview process.
I am aware that a person who asserts an entitlement to any rights on the basis of information which he or she knows to be false or misleading in a material particular shall be guilty of an offence and shall be liable, on summary conviction or conviction on indictment, to a fine or term of imprisonment, or both, as set out in Regulation 30 of the European Communities (Free Movement of Persons) Regulations 2015.
Signed by EU citizen Date
D D M M Y Y Y Y
Day Month Year
Please return completed forms and documents to:
Permitted Family Member Assessment
EU Treaty Rights Unit
Residence Division
Irish Naturalisation and Immigration Service
13/14 Burgh Quay
Dublin 2
D02 XK70
Sending this application to any other address may delay your application. We recommend that you
send your application by Registered Post and track it on the An Post website: www.anpost.ie. All
documents submitted with this application form should be photocopies. A decision will be made on
your application based on the information contained in this application form and the supporting
documents you submit with this form. Please ensure that you fully complete all relevant sections and
submit all required documents. No further information or documentation will be requested.
