Nhs Funding For Treatment In The European Economic Area (Eea) Application Form Page 8
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10Part 5: Residence
By ticking the following box, I confirm that I am ordinarily resident in England (living
lawfully, on a settled basis), and entitled to receive NHS services:
Are you currently residing at the permanent address you have provided on page 2?
Yes
No
Is this address your permanent residence at the time of treatment?
Yes
No
If No: Where are you currently residing (address / country)? ____________________________
_______________________________________________________________________
How long have you been there? _____________________________________________
How long are you intending to reside there? ___________________________________
What is the reason for you not currently residing at your permanent address (e.g. work, study,
health)? _____________________________________________________________________
Part 6: Supporting information
(please reference Part / Question number and continue on a separate sheet if needed)
10. EEA application form (04 /15)
Page 8 of 10
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