EUTR1

Application for a Residence Card for a qualifying family member of

a European Union national

Who is this form for?

Please read the information below carefully before you submit your application. If you do not
submit sufficient information and/or evidence to show you qualify for a residence card your
application may be refused.

You should use this application form if:

 You are a non-EEA national resident in Ireland who is a qualifying family member of an EEA
national
 The EEA national is residing in Ireland
 The EEA national is exercising their EU Treaty Rights in the State (employed, self-
employed, residing with sufficient resources, studying or involuntarily unemployed)

Which qualifying family members can apply on this form?

If the EEA national is residing in Ireland as a student you must be the:

 Spouse or recognised civil partner of the EEA national, or

 Dependent child of the EEA national or of their spouse/recognised civil partner

In all other cases, you must be the:

 Spouse or recognised civil partner of the EEA national, or

 Child or grandchild of the EEA national, or of their spouse/recognised civil partner, and be
aged under 21 or dependent, or
 Dependent parent or grandparent of the EEA national or of their spouse/recognised civil
partner.

If you are a family member of an EEA national but do not fall within the criteria listed
above, you should apply on Form EU1A

How to complete this form:

 You must complete a separate application for each non-EEA family member, including each
child under 18 years of age.
 You must complete this form in CAPITAL letters
 You must place a tick () in the boxes that are relevant to you
 You must complete all sections of this form which are relevant to you in full

Form EU1 (10/2018) - Page 1 of 44

 You must submit photocopies of supporting documents for each application
 You must complete the checklists on pages 20, 21 and 39 for each application
 You, the applicant, must sign and date the declaration on page 22
 The EEA national must sign and date the declaration on page 40
 If you or the EEA national are unable to provide any of the information requested at this time,
please explain the reason in writing and enclose with this application.
 You must send your completed application form and any supporting documents you wish to
provide to the address below

EU Treaty Rights Division

Irish Naturalisation and Immigration Service
13/14 Burgh Quay,
Dublin 2,
D02 XK70

 Your application may be delayed if you do not send it to the address listed above
 We recommend you send your application by registered post
 If you choose to send your application by registered post you can track it on the An Post
website, www.anpost.ie

Warning:

If you have a change in circumstances while your application is being processed, for example:
 If you change your personal details (your name etc.)
 If your contact details change (your address or representative etc.)
 If there is a change in other circumstances (your EEA national family member leaves Ireland
etc.)
you must inform EU Treaty Rights Division office immediately and provide any relevant
supporting documentation.

Form EU1 (10/2018) - Page 2 of 44

 Data privacy notice

1. The data you provide in this form is collected by the Irish Naturalisation and Immigration Service
(INIS), a part of the Department of Justice and Equality. The data controller for the information
you provide is the Department of Justice and Equality. The data controller’s contact details are:
EU Treaty Rights Division, Irish Naturalisation and Immigration Service, Department of Justice
and Equality, 13 – 14 Burgh Quay, Dublin 2, D02 XK70.

2. You can contact the Data Protection Officer for the Department of Justice by writing to: The Data
Protection Officer, Department of Justice and Equality, 51 St. Stephen’s Green, Dublin 2, D02
HK52. Or by email: dataprotectioncompliance@justice.ie

3. We will use the personal data you provide in this form for the purpose of assessing your
entitlement to reside in the State as the family member of the EEA national named in your
application

4. We collect and process this data in order to comply with our legal obligations or to perform tasks
in the public interest. The specific basis for collecting and processing this data is as follows:

 Directive 2004/38/EC
 Regulation 26 of the EC (Free Movement of Persons) Regulations 2015
 Section 8 of the Immigration Act, 2003
 The Immigration Act 2004
 The Immigration Act 2003
 The Immigration Act 1999

5. The personal data provided here will be stored securely in INIS’s databases. It may be shared, if
necessary, with the following third parties:

 Government departments and agencies,

 An Garda Siochána
 EEA competent authorities
 EEA police forces
 Individuals with your consent, for example, employer, landlord
 Service providers of the Department of Justice and Equality, for example data handling and
storage providers, producer of Residence Card/Irish Residence Permit.

6. The personal data you provide in this form is necessary for us to determine if you meet the
criteria for a residence card as the family member of the EEA national named by you. If this data
is not provided, your application cannot be processed.

Form EU1 (10/2018) - Page 3 of 44

 7. This data may be retained until INIS can be sure that neither party will have any further contact
with the immigration services. This is an indeterminate period as your immigration history in the
State may span a full lifetime.

8. Both you and the EEA national have the right to request access to, and a copy of any personal
data pertaining to you or them that we process. You can do this by filling in a Subject Access
Request form, available at http://www.justice.ie/en/JELR/Pages/Data_Protection, and sending it
to subjectaccessrequests@justice.ie. You may be required to verify your identity before we send
the information to you.

9. You or the EEA national have the right to request us to rectify any errors in your data or to erase
your data, as well as to seek a restriction of the processing of your data or to object to the
processing of your data in certain circumstances. To do this you or the EEA national should
write to EU Treaty Rights Division, Irish Naturalisation and Immigration Service, the Department
of Justice and Equality, 13 – 14 Burgh Quay, Dublin 2, D02 XK70 explaining what errors need to
be rectified or erased or your reasons for seeking the restriction of, or objecting to, the
processing.

10. You or the EEA national have a right to lodge a complaint with the Data Protection Commission
if you believe your personal data is being processed by us unlawfully. Information about how to
make a complaint can be found on www.dataprotection.ie.

I acknowledge that I have read and understood the information outlined above, which relates to
my data protection rights.

Name _____________________________

Signature (Applicant) ________________________ Date ____________________

Name of Parent/Guardian if applicant is under 18 _________________________________

Signature of Parent/Guardian _______________________________ Date __________________

Signature (EEA national) ________________________ Date ____________________

Form EU1 (10/2018) - Page 4 of 44

 Section 1 Applicant’s personal details

1.1 Surname/Family name (as shown in passport)

1.2 Forename(s) (as shown in passport)

1.3 Other name(s) (maiden name, name at birth, any other names) by which you are or have
been known

1.4 If you have been known by any other name(s), what dates did you use this/these names?

1.5 If you changed your name, why did you change it? ( )

Marriage/civil partnership Divorce Other

If “other” please explain

1.6 Date of birth 1.7 Gender ( )

D D M M Y Y Y Y Male Female Other

1.8 What is your relationship status? ()

Recognised
Single Married Divorced Widowed
civil partner
Surviving
Unmarried
recognised civil
partner
partner

1.9 Nationality

1.10 Place and country of birth

Form EU1 (10/2018) - Page 5 of 44

1.11a Do you hold, or have you ever held any other Nationality or Citizenship? ()
Yes (tick relevant box and give details) No

Citizenship
Nationality

1.11b If you have ticked one of the above boxes, please give dates you held this
Citizenship/nationality

D D M M Y Y Y Y TO D D M M Y Y Y Y

1.11c Details of the citizenship/nationality which you have indicated above

1.12 Current home address in Ireland

1.13 How many family members reside with you?

1.14 Address Eircode 1.15 Contact telephone number of applicant

1.16 Email address

1.18 Old Department of Justice reference

1.17a PPS number (if you have one)
number (if you have one)
6 9

1.17b Date PPS number was issued 1.19 Passport number

D D M M Y Y Y Y

1.20 INIS Person ID number (if you have one)

Form EU1 (10/2018) - Page 6 of 44

 Section 1B Immigration history of applicant

1.21 What date did you move to Ireland?

D D M M Y Y Y Y

1.22 GNIB ID (if you have one)

1.23 How did you enter Ireland? ()

Airport Seaport Land Border

1.24 Where did you arrive in Ireland? (For example, Dublin Airport, Rosslare, Shannon etc.)

1.25 What was your status on arrival in Ireland ()

Family member of Employment permit or green Card
Asylum-seeker
EEA national permit
Student Visitor Entry without permission

Other (please give

details):

1.26 Have you previously applied for permission to visit or reside in Ireland or 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 Result of Duration of

Country applied to
applied for application permission/visa

1.27 How long do you intend on staying in Ireland? (for example permanently, for the duration
of a work contract, for the duration of a course of study etc.)

Form EU1 (10/2018) - Page 7 of 44

1.28 Do you hold or have you previously held, a residence card issued by Ireland or another EU
Member State? ()

Yes (give details below) No

1.29 Have you previously been refused a residence card by Ireland or another EU Member State?
()

Yes (give details below) No

Form EU1 (10/2018) - Page 8 of 44

 Section 1C Applicant’s relationship to EEA national

1.30 This section looks for how are you related to the EEA national. Please tick relevant box
and fill out the corresponding subsection on this form ()

Spouse - Complete subsection (i)

Recognised Civil Partner – Complete subsection (i)

Child aged under 21 of the EEA national or of the EEA national’s spouse or
Recognised Civil Partner – Complete subsection (ii)
Grandchild aged under 21 of the EEA national or of the EEA national’s spouse or
Recognised Civil Partner – Complete subsection (ii)
Dependent child aged 21 or over of the EEA national or of the EEA national’s
spouse or Recognised Civil Partner – Complete subsection (ii)
Dependent parent of the EEA national or their spouse or Recognised Civil
Partner – Complete subsection (ii)
Dependent grandchild aged 21 or over of the EEA national or of the EEA
national’s spouse or Recognised Civil Partner – Complete subsection (ii)
Dependent grandparent of the EEA national or of the EEA national’s Spouse or
Recognised Civil Partner – Complete subsection (ii)

Please complete this section if you are the spouse or

Subsection (i)
recognised civil partner of the EEA national

1.31 When did you meet the EEA national?

M M Y Y Y Y

1.32 Where did you first meet the EEA national?

Form EU1 (10/2018) - Page 9 of 44

1.33 When did your relationship begin?

1.34 Are you related to the EEA national outside your marriage or civil partnership? ()
Yes (give details below) No

1.35 Do you and the EEA national currently live together? ()
Yes No

1.36 If no, have you ever lived together in Ireland or any other country? ()
Yes No

1.37 When and where did you start living together?

1.38 Please provide all addresses where you and the EEA national have lived together

Address Date from Date to

Form EU1 (10/2018) - Page 10 of 44

1.39 When did you decide to marry or form a Recognised Civil Partnership with the EEA
national?

1.40 Date of marriage or civil partnership?

D D M M Y Y Y Y

1.41 Please tick which type of marriage or partnership applies to your relationship with the EEA
national (If other give details) ()

Recognised Civil Registered Religious/Traditional Proxy

Other (please give details):

1.42 What is the address where your marriage or civil partnership took place?

1.43a Were both you and the EEA national present at the ceremony? ()
Yes No
1.43b If no, please explain where you and the EEA national were at the time of the ceremony.

1.44 Have you previously submitted a notice of intention to marry to a Registrar in Ireland? ()

Yes (give date below) No

D D M M Y Y Y Y

Form EU1 (10/2018) - Page 11 of 44

1.45 Has there been an objection to your intention to marry in Ireland? ()
Yes (give date below) No
D D M M Y Y Y Y

1.46 Have you previously applied to marry in another country? () If yes, please give the
country and the date
Yes No
C O U N T R Y D D M M Y Y Y Y

1.47 Have you previously been refused permission to marry, or had an objection raised against
your intention to marry in a country other than Ireland? ()
Yes No
If you answered ‘Yes’, please provide details here:

1.48 Have you ever been considered to be party to a marriage of convenience by a competent
authority in a country other than Ireland? ()
Yes No
If you answered ‘Yes’, please provide details here:

1.49 If you answered ‘Yes’s to the last question, please provide the country, date and any
details of the decision
C O U N T R Y D D M M Y Y Y Y

1.50 Do you or the EEA national currently have another spouse or civil partner, or an unmarried
partner, with whom either of you are in a durable relationship? ()

Yes (give details below) No

Form EU1 (10/2018) - Page 12 of 44

1.51a Have you or the EEA national been married or in a civil partnership before? ( )

Yes (if yes give date below) No

1.51b Date of divorce, annulment or dissolution

D D M M Y Y Y Y

1.52 Do you and the EEA national have any children together? ( )
Yes No

1.53 Do you have any children of whom the EEA national is not the biological parent (for
example from a previous relationship)? ( )
Yes No

Please complete if you are:

- the dependent child of the EEA national
Subsection (ii)
- grandchild, parent or grandparent of the EEA national
- or the spouse or civil partner of the EEA national

1.54 How long have you been dependent on the EEA national?

1.55 Does the EEA national regularly give you money? ( )

Yes (give details below) No

Method of payment (for How much you receive How often you receive it
example cash, EFT)

1.56 Do you receive financial assistance from any other relative, friend or any other source? ()
Yes (give details below) No
Source of income How much you receive How often you receive it

Form EU1 (10/2018) - Page 13 of 44

1.57 Do you and the EEA national currently live together? ( )
Yes No

1.58 If no, have you ever lived together in Ireland or any other country? ( )
Yes No

1.59 When and where did you start living together?

1.60 Please provide all addresses where you and the EEA national lived together.

Address Date from Date to

1.61 Do you pay any rent, mortgage or other payment for your accommodation? ( )

Yes (give details below) No

Expenditure Amount Who pays(for example you, relative)
Rent/Mortgage
Gas
Electricity
Phone
Food
Clothing
Medical Care
Other

Form EU1 (10/2018) - Page 14 of 44

1.62 Please provide any other relevant information about how you are dependent on or receive
support from the EEA national

Form EU1 (10/2018) - Page 15 of 44

 Section 2 Applicant’s personal history

 This section asks about any criminal convictions you have.

 This section asks about any involvement you may have had in war crimes, genocide,
crimes against humanity or terrorism.
 Please note, if you have received more than 3 charges/indictments/convictions, please
photocopy the relevant sections and enclose those completed sections with this form
 If you fail to answer all of these questions as fully and accurately as possible, your
application for a residence card may be refused

Warning
It is an offence under Regulation 30 of the European Communities (Free Movement of
Persons) Regulations 2015 to make a statement that you know to be false or misleading.

2.1 Have you ever been charged or indicted in any country with a criminal offence for which you
have not been tried in court? ()
Yes (give details below) No

Charge/Indictment No. 1

Name under which you were charged/indicted

Country where you were charged/indicted

Type of offence

Charge/Indictment No. 2

Name under which you were charged/indicted

Country where you were charged/indicted

Type of offence

Charge/Indictment No. 3

Name under which you were charged/indicted

Country where you were charged/indicted

Type of offence

Form EU1 (10/2018) - Page 16 of 44

2.2a Have you ever been convicted of an offence in Ireland or abroad? () If yes, please provide
details for EACH criminal conviction, starting with the most recent one.
Yes (give details below) No

Criminal conviction 1

Name under which you were convicted

Country where you were convicted

Type of offence

Sentence given

Date sentenced

Term of imprisonment, if any, in months

Criminal conviction 2

Name under which you were convicted

Country where you were convicted

Type of offence

Sentence given

Date sentenced

Term of imprisonment, if any, in months

Criminal conviction 3

Name under which you were convicted

Country where you were convicted

Type of offence

Sentence given

Date sentenced

Term of imprisonment, if any, in months

2.2b Are you now, or have you ever been required to comply with conditions following release from
prison? (for example a period of probation or restricted licence) ()

Yes (give details below) No

Type of condition imposed

Date condition started
Term of condition (date of expiry)

2.2c Did you comply, or are you in compliance with the imposed conditions or restrictions? ()

Yes No

Form EU1 (10/2018) - Page 17 of 44

2.3 Have you ever been a member of, or given support to, an organisation, which has been
linked with terrorism? ()

Yes (give details below) No

2.4 Have you, in either peace time or war time, ever been involved in, or been suspected of
being involved in, war crimes, crimes against humanity or genocide? ()

Yes (give details below) No

2.5 Have you ever been involved in, supported, or encouraged terrorist activities in any country?
()

Yes (give details below) No

2.6 Have you ever served in a military force or State-sponsored private militia, undertaken any
military or paramilitary training, or been trained in the use of weapons and/or explosives? ()

Yes (give details below) No

Form EU1 (10/2018) - Page 18 of 44

2.7 Have you ever been deported/removed from Ireland or another country? ()

Yes (give details below) No

Date of
deportation/removal
Country
deported/removed from
Country
deported/removed to

2.8 Are you, or have you ever been, subject to a deportation, exclusion or removal order in
Ireland or any other country? ()

Yes (give details below) No

Type of order
Date of order
Status of order

2.9 Have you ever been denied permission to enter or remain in any other country? ()

Yes (give details below) No

Type of permission
denied
Name of country

2.10 Provide details of all countries you have visited in the last 10 years. If necessary,
photocopy this section and submit with this application?
Country Date of travel Reason for visit Length of stay

Form EU1 (10/2018) - Page 19 of 44

Section 3 Applicant’s document and evidence checklist

 Please complete this checklist to show what documents you are providing with your
application
 If you do not submit evidence to show that you qualify for a residence card, your
application may be refused
 If you wish to send any documents that are not in English, you must get the document
translated by a qualified professional translator. The translator must confirm in writing on
the translation:
 that the translation is a true and accurate translation of the original document
 the date of the translation
 the full name and contact details of the translator or representative of the
translation company
 INIS will not provide written correspondence acknowledging each document you submit
with this application
Tick if you For
have Number official
Description submitted of pages
use
()
Identity documents

1. Passport of the applicant

2. Passport/National Identity Card of the EEA national

3. 2 passport photos for both the applicant and the EEA national

Residency documents if renting

4. Tenancy Agreement

5. Letter from landlord/letting agent including contact details

6. Letter from local authority/County Council

7. Utility bills in your name and the EEA national’s name

8. Bank statements

9. Evidence of rent payments

Residency documents if a home owner

10. Title or Deeds as applicable

11. Letter from Mortgage Provider/Local authority/County Council

12. Utility bills in your name and the EEA national’s name

Residency documents if living with a home owner

13. Evidence of home ownership, e.g. title deeds/letter from mortgage provider

14. Utility bills in the home owner’s name

Form EU1 (10/2018) - Page 20 of 44

 Letter from the home owner confirming your and the EEA national’s residency
15.
there
Residency documents if you are living with a tenant

16. Tenancy agreement in their name

Letter from the tenant confirming the residence of you and the EEA national
17.
including contact details

Letter from landlord confirming the residence of you and the EEA national
18.
including contact details

19. Utility bills in the tenant’s name.

Evidence of relationship

20. Civil marriage certificate

21. Recognised civil partnership certificate

22. Birth certificate

23. Evidence of guardianship/custody papers/ adoption papers

24. Copy of any previously held residency card

Any other documents you have submitted in this application

25.

26.

27.

28.

29.

30.

31.

32.

33.

Form EU1 (10/2018) - Page 21 of 44

Section 4 Applicant’s declaration

You (the applicant) must read the declaration below and sign it. It must be signed by you
and not by a representative or other person acting on your behalf. If you are under 18, your
parent or guardian may sign it.
Warning: If you do not submit a signed declaration your form will be returned to you.
I hereby apply for a residence card for myself. 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 Division 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 acknowledge that the EU Treaty Rights Division may make 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 to a fine not exceeding €5,000 or to a term of
imprisonment not exceeding 12 months, or both.

Name of applicant (BLOCK CAPITALS)

Date Signed by applicant

D D M M Y Y Y Y

Name of parent/guardian of applicant if aged under 18 (BLOCK CAPITALS)

Date
D D M M Y Y Y Y

Signed by parent/guardian of applicant if aged under 18

Form EU1 (10/2018) - Page 22 of 44

 Section 5 EEA national’s details
5.1 Surname / family name (as in passport)

5.2 Forename(s) (as in passport)

5.3 Other name(s) (maiden name, name at birth, any other names by which you are or have
been known)

5.4 Dates during which you have used this/these names

5.5 Reason for name change (if applicable) ()

Marriage/Civil partnership Divorce Other

If “other” please explain

5.6 Date of birth 5.7 Gender ()

D D M M Y Y Y Y Male Female Other

5.8 Relationship status ()

Recognised
Single Married Divorced Widowed
Civil partner
Surviving
Unmarried
Recognised
Partner
Civil Partner

5.9 Nationality

Form EU1 (10/2018) - Page 23 of 44

5.10 Place and country of birth

5.11 Do you hold, or have you ever held any other nationality or citizenship? ()
Yes (please tick the relevant box and
No
give dates and details)

Citizenship
Nationality

D D M M Y Y Y Y TO D D M M Y Y Y Y

5.12 Current home address in Ireland

5.13 Address Eircode 5.14 Contact telephone number

5.15 Email address

5.16 PPS number (if applicable)

5.17 Passport/national identity card number

Form EU1 (10/2018) - Page 24 of 44

 Section 5B Immigration history of the EEA national

5.18 What date did you move to Ireland?

D D M M Y Y Y Y

5.19 How did you enter Ireland? ()

Airport Seaport Land border

5.20 Where did you arrive in Ireland? (For example, Dublin Airport, Rosslare, Shannon etc.)

5.21 Have you previously resided in Ireland? () If yes give details and dates

Yes (give details below) No

5.22 How long do you intend to stay in Ireland?

Form EU1 (10/2018) - Page 25 of 44

 Section 5C EEA national’s current activity in Ireland

This section asks for details on your current activity in Ireland. The section is divided into five
parts. Please only complete the section which is relevant to you, (for example if you are
employed, you should complete Section A.

5.23 Please indicate the type of activity ()

Employment – Complete Section A

Self-employment – Complete Section B

Study – Complete Section C
Involuntary Unemployment – Complete Section D
Sufficient Resources – Complete Section E

Section A For an EEA national who is in employment

Complete this section if you are currently working for an employer. Please note, you must also
submit a fully completed Employer Declaration in addition to the required employment
documents with this application. This declaration is set out in Appendix ‘A’ of this application
form.

5.24 Name of employer

5.25 Contact name

5.26 Email address of employer

5.27 Contact telephone number of employer

Form EU1 (10/2018) - Page 26 of 44

5.28 Workplace address

5.29 Workplace Eircode

5.30 Start date for employment

D D M M Y Y Y Y

5.31 Type of contract, e.g. fixed term/temporary/permanent

Form EU1 (10/2018) - Page 27 of 44

 Section B For an EEA national who is self-employed

Complete this section if you are a self-employed EEA national

5.32 Name of business

5.33 Class of self-employment (). If other, give details

Sole Trader Partnership Limited company

Other:

5.34 Type of business (e.g. services offered, products made/sold)

5.35 Address of business

5.36 How do you, the EEA national, advertise the business?

5.37 Contact telephone number of business

5.38 Email address of business

5.39 Website address for the business if applicable

Form EU1 (10/2018) - Page 28 of 44

5.40 Date business started trading 5.41 Number of employees

D D M M Y Y Y Y

5.42 Date you registered with Revenue for self-assessment

D D M M Y Y Y Y

5.43 Has a P35 return been made for the business? ()
Yes No

5.44 Date on which tax returns are due 5.45 Do you pay PRSI? ()
D D M M Y Y Y Y Yes No

5.46 Is the business registered for VAT? ()

Yes No

5.47 Name of accountant/tax advisor if applicable

5.48a Are you a director of the company in which you are self-employed? ()

Yes No

5.48b If yes, do you pay PAYE returns? ()

Yes No

5.49 What is your role in the business

5.50 Monthly operating costs 5.51 Monthly net income

€ €
5.52 Hours worked monthly

Form EU1 (10/2018) - Page 29 of 44

 Section C For an EEA national who is studying

Complete this section if you are undertaking a course of study which is on the interim list of
eligible programmes (ILEP)

5.53 Name of college/institution

5.54 Name of course

5.55 Qualification

5.56 Awarding body

5.57 Is the course delivered via distance learning? ()

Yes No

5.58 Website for college/institution

5.59 Address of college/institution

5.60 Contact telephone for college/institution

5.61 When did your course begin? 5.62 When will your course end?
D D M M Y Y Y Y D D M M Y Y Y Y

Form EU1 (10/2018) - Page 30 of 44

5.63 Intended activity on completion of course

5.64 Please provide details of your financial resources (e.g. unemployment/social assistance,
savings, scholarship, bursary, income from relative/friend, income from employment/self-
employment/rental property). State how much you receive and how often (e.g. weekly, monthly,
annually)
Source of income How much you receive How often do you receive it?

5.65 Name of the person(s) providing financial support

5.66 Method of payment (i.e. cash, bank transfer etc.)

5.67 Do you have comprehensive private medical insurance for yourself and your dependents
residing with you in Ireland? ()

Yes (give details below) No

Form EU1 (10/2018) - Page 31 of 44

 Section D For an EEA national who is involuntarily unemployed

If you are temporarily unable to pursue work, please give details below

5.68 Name of most recent employer

5.69 Address of most recent employer

5.70 Contact telephone for most recent employer

5.71 Date most recent employment started 5.72 Date most recent employment ended
D D M M Y Y Y Y D D M M Y Y Y Y

5.73 Why did this employment end?

5.74 Are you registered with the Department

5.75 Are you in receipt of any payment from
of Employment and Social Protection
DEASP? ()
(DEASP)? ()
Yes No Yes No

5.76 If you are in receipt of any payments from DEASP, please provide details below.
Type of payment Date payments started Amount you receive (weekly)

Form EU1 (10/2018) - Page 32 of 44

 For an EEA national who is residing with sufficient
Section E
resources

Complete this section if you are residing in the State with enough financial resources available
so as not to become a financial burden on the State.

5.77 Date EEA national first resided in

the State with sufficient resources
D D M M Y Y Y Y

5.78 Source of income () If other, give details

Pension Stocks/Shares etc. Third party funds
Other:

5.79 Are you receiving any State funds from this or any other State? ()

Yes (give details below) No

5.80 Name of person who owns the funds available to you, the EEA national, their relationship
to you and their current place of residence.

5.81 Amount of funds available

5.82 If funds are from a third party, please provide details below
Method of payment Regularity of payments Amount you receive

Form EU1 (10/2018) - Page 33 of 44

5.83 Monthly living expenses for you and your dependants
Expenditure Amount
Rent/Mortgage
Gas
Electricity
Phone
Food
Clothing
Medical Care

Other

5.84 Do you have comprehensive private medical insurance for yourself and your dependents
residing with you in Ireland? ()

Yes (give details below) No

Insurance provider

Name of plan and policy number

When did the plan commence?

Evidence of payment

Form EU1 (10/2018) - Page 34 of 44

 Section 6 EEA national’s personal history

 This section asks about any criminal convictions you have.

 This section asks about any involvement you may have had in war crimes, genocide,
crimes against humanity or terrorism.
 Please note, if you have received more than 3 charges/indictments/convictions, please
photocopy the relevant sections and enclose the completed sections with this form
 If you fail to answer all of these questions as fully and accurately as possible, your
application for a residence card may be refused

6.1 Have you ever been charged or indicted in any country with a criminal offence for which you
have not been tried in court? () If you have received more than 3 charges/indictments, please
photocopy this page and enclose the completed section with this form

Yes (give details below) No

Charge/Indictment No. 1

Name under which you were charged/indicted

Country where you were charged/indicted

Type of offence

Date of trial

Charge/Indictment No. 2

Name under which you were charged/indicted

Country where you were charged/indicted

Type of offence

Date of trial

Charge/Indictment No. 3

Name under which you were charged/indicted

Country where you were charged/indicted

Type of offence

Date of trial

Form EU1 (10/2018) - Page 35 of 44

6.2a Have you ever been convicted of an offence in Ireland or abroad? () If yes, please
provide details for EACH criminal conviction, starting with the most recent one. If you have
received more than 2 criminal convictions, please photocopy this page and enclose the
completed section with this form.

Yes (give details below) No

Criminal conviction 1

Name under which you were convicted

Country where you were convicted

Type of offence

Sentence given

Date sentenced

Term of imprisonment, if any, in months

Criminal conviction 2

Name under which you were convicted

Country where you were convicted

Type of offence

Sentence given

Date sentenced

Term of imprisonment, if any, in months

6.2b Are you now, or have you ever been required to comply with conditions following release
from prison? (for example a period of probation or restricted licence)()

Yes (give details below) No

Type of condition imposed

Date condition started
Term of condition (date of expiry)

6.2c Did you comply, or are you in compliance with the imposed conditions or restrictions?
()
Yes No

Form EU1 (10/2018) - Page 36 of 44

6.3 Have you, in either peace time or war time, ever been involved in, or been suspected of
involvement in, war crimes, crimes against humanity or genocide? ()

Yes (give details below) No

6.4 Have you ever been involved in, supported, or encouraged terrorist activities in any
country? ()
Yes (give details below) No

6.5 Have you ever been a member of, or given support to an organisation, which has been
associated with terrorism? ()
Yes (give details below) No

6.6 Have you ever served in a military force, or State-sponsored private militia, undergone any
military or paramilitary training or been trained in the use of weapons and/or explosives? ()

Yes (give details below) No

6.7 Have you ever been deported/removed from Ireland or another country? ()
Yes (give details below) No
Date of deportation/removal

Country deported/removed from

Country deported/removed to

Form EU1 (10/2018) - Page 37 of 44

6.8 Are you, or have you ever been, subject to a deportation, exclusion or removal order in
Ireland or any other country? ()
Yes (give details below) No
Type of order

Date of order

Status of order

6.9 Have you ever been denied permission to enter or remain in any other country? ()

Yes (give details below) No

Type of permission denied

Name of country

Date of denial of permission

6.10 Provide details of all countries you have visited in the last 10 years. If necessary,
photocopy this section and submit with this application
Country Date of travel Reason for visit Length of stay

6.11 Do you have any children living in Ireland or any other country of whom the applicant is not
the parent? () If yes, please provide names, dates of birth and current locations of the
children
Yes (give details below) No

Form EU1 (10/2018) - Page 38 of 44

Section 7 EEA national’s document and evidence checklist

Tick if you For

have Number official
Evidence of the EEA national’s current activity in the State submitted of pages
use
()
If the EEA national is in employment
1. Declaration signed and stamped by employer (appendix 1)

2. Signed and dated contract of employment

3. 2 recent payslips

4. Most recent P60 certificate or amended tax credit certificate

5. Corresponding bank statements to show earnings

If the EEA national is self-employed
6. Agreed tax assessment from Revenue for last financial year

7. Letter of registration for self-assessment of income tax (Revenue)

8. Certificate from Companies Registration Office

9. Sales/Service invoices for the last 6 months

10. Corresponding bank statements for the business for the last 6 months
If the EEA national is studying
11. Letter from course provider, including course description, start date and end date

12. Letter from private medical insurance provider for EEA national and dependents

13. Copy of private health insurance policy

14. Evidence of payment of private health insurance policy

If the EEA national is involuntarily unemployed
Letter from Department of Employment and Social Protection outlining any benefits
15.
which have been received
16. Letter from most recent employer outlining circumstances of redundancy

17. P45 certificate for last employment

18. P60 certificates for previous 2 years

If the EEA national is residing with sufficient resources
19. Evidence of EEA national’s financial resources e.g. bank statements
Letter from Department of Employment and Social Protection outlining any benefits
20.
which have been received
21. Letter from private medical insurance provider for EEA national and dependents

22. Copy of private health insurance policy

23. Evidence of payment of private health insurance policy

Form EU1 (10/2018) - Page 39 of 44

Section 8 EEA national’s declaration

You (the EEA national) must read the declaration below and sign. It must be signed by
you and not by a representative or other person acting on your behalf. If you are under
18, your parent or guardian may sign it.

Declaration
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
Division 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 acknowledge that the EU Treaty Rights Division may make 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 to a fine not exceeding €5,000 or to a term
of imprisonment not exceeding 12 months, or both.

Name of applicant (BLOCK CAPITALS)

Date Signed by applicant

D D M M Y Y Y Y

Name of parent/guardian of applicant if aged under 18 (BLOCK CAPITALS)

Date
D D M M Y Y Y Y

Signed by parent/guardian of applicant if aged under 18

Form EU1 (10/2018) - Page 40 of 44

 Appendix A EEA national’s declaration of employment

 This section asks about the EEA national’s employment.

 Please give details of your employer below.
 If you have more than one employment, you should copy Appendix A and B, complete for
every employment and enclose with the application
 Please also provide proof of your income or salary
 Wage slips for the last 3 months and bank statements showing receipt of income should be
provided.
 Please complete the checklist on page 39
 We may contact your employer to verify the information you provided.

A1 Name of employer (business or company)

A2 Type of business (e.g. services offered, products made/sold)

A3 Address of business

A4 Business Eircode A5 Contact telephone number for employer

A6 What date did you start your employment with the business?
D D M M Y Y Y Y

A7 How many hours per week do you work on average?

A8 Salary/Wages

€
Form EU1 (10/2018) - Page 41 of 44
A9 Frequency of payment ()
Weekly Monthly Annually

A10 Please indicate what type of employment this is ()

Permanent full time Part time Temporary

If you answered temporary, please give the expected duration of the contract

Form EU1 (10/2018) - Page 42 of 44

 Appendix B Employer’s declaration

 This section must be completed in full and submitted with your application form and should
be stamped where applicable.
 It must be signed and dated by your employer/s
 INIS may contact your employer to verify the information provided

B1 Name of business or company

B2 Type of business (e.g. services offered, products made/sold)

B3 Address of business

B4 Business Eircode B5 Contact telephone number for business

B6 What date did this person start their employment with the business?
D D M M Y Y Y Y

B7 How many hours per week do they work on average?

B8 Salary/Wages

B9 () Frequency of payment

Weekly Monthly Annually

Form EU1 (10/2018) - Page 43 of 44

B10 Method of payment ()
Cash Cheque EFT (electronic funds transfer) Other (Please explain below)

B11 Please indicate what type of employment this is ()

Permanent full time Part time Temporary

B12 Name (employer or authorised person)

B13 Position held in the company

I can confirm that ________________________________ (name of employee) has been, and

is currently, employed by _______________________________ (name of company) as set out

above.

B14 Signature

B15 Date
D D M M Y Y Y Y

B16 Company stamp or seal (If you do not have one, state “none”)

Form EU1 (10/2018) - Page 44 of 44