EEA(PR) - Version 03/19
Page 82 of 85
Section 19 - Declarations
You (the applicant) should complete subsection A and your sponsor (named in section 2 of this
form, if relevant) should complete subsection B, unless they are unable to do so.
A. Applicant’s declaration
Please read the declaration below and sign it. It should be signed by you (the applicant) and not
by a representative or other person acting on your behalf. If you are under 18, your parent or
guardian may sign it.
I hereby apply for a document certifying permanent residence / permanent residence card for
myself and any family members included in this application. The information I have given in this
form is complete and is true to the best of my knowledge.
I conrm that the photographs submitted with this form are a true likeness of me and my family
members, as named on the back of each photograph, and that I have had the opportunity to see
the Home Oce photograph guidance.
I conrm that if, before this application is decided, there is a material change in my
circumstances or new information relevant to this application becomes available, I will inform the
I understand that all information provided by me to the Home Oce will be treated in condence
but that it may be disclosed to other government departments, agencies, local authorities, the
police, foreign governments and other bodies for immigration purposes or to enable them to
perform their functions, and that, if such bodies provide the Home Oce with any information
about me which may be relevant for immigration purposes, it may be used in reaching a decision
on my application or on whether I or my family members have, or my sponsor has, a right of
I understand that my details may in certain circumstances be passed to fraud prevention
agencies to prevent and detect fraud and money laundering. I also understand that such
agencies may provide the Home Oce with information about me. Further details explaining
when information may be passed to or from fraud prevention agencies and how that information
may be used can be obtained from the Home Oce website.
I understand that documents provided in support of this application will be checked for
authenticity, and that false documents will be retained and may result in my application being
refused and in my prosecution and subsequent removal from the UK.
I understand that the Home Oce may also use the information provided by me for training
I am aware that it is an oence to make a statement or representation which I know to be false
or do not believe to be true, or to obtain, or seek to obtain a document certifying permanent
residence or permanent residence card by means which include deception.
I understand that if I am, or anyone included in this application is, informing the Home Oce that
I or they have changed gender, these details may in certain circumstances be shared with other
Home Oce colleagues. I consent to this, where necessary, and understand that this information
will only be shared in limited circumstances relating to identity and security in line with section 22
of the Gender Recognition Act. I am aware they will otherwise be treated in condence and that
my rights under the Equality Act 2010, Data Protection Act 2018 and Article 8 of the European
Convention on Human Rights will be unaected.
Signed Date D D M M Y Y Y Y