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Main Applicant Details

Spouse / Partner Details

Yes No

Dependent Child Details

Yes No

Child no.: #{{$index+1}}

 

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Acknowledgement

I acknowledge that I will lose the right to cancel the order within the statutory period of 14 working days as we will commence the delivery of an order immediately and before this statutory period ends. Therefore the services will have deemed to have been provided and you will lose the right to cancel your order. I acknowledge that I have British, EU, EEA or Swiss nationality and that all persons to be specified in this application are UK residents. I understand that should any person on this application decide to remain abroad to live or work, then the relevant authorities must be informed and the EHIC returned. The information that I give on this form is correct and complete to the best of my knowledge.
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Main Applicant Details

Title: {{formData.ma_title}}
Forename(s): {{formData.ma_forename}}
Surname:{{formData.ma_surname}}
Date of Birth: {{formData.ma_dob}}
NHS or NI No.: {{formData.ma_nhs_or_ni_no}}
EHIC PIN Number: {{formData.ma_ehic_pin_number}}

Spouse / Partner Details

Title: {{formData.pa_title}}
Forename(s): {{formData.pa_forename}}
Surname:{{formData.pa_surname}}
Date of Birth: {{formData.pa_dob}}
NHS or NI No.: {{formData.pa_nhs_or_ni_no}}
EHIC PIN Number: {{formData.pa_ehic_pin_number}}

Dependent Child Details

Number of Children: {{formData.ca_number}}

Children No.#: {{$index+1}}

Title: {{formData.ca_title[$index+1]}}
Forename(s): {{formData.ca_forename[$index+1]}}
Surname:{{formData.ca_surname[$index+1]}}
Date of Birth: {{formData.ca_dob_d[$index+1]}}-{{formData.ca_dob_m[$index+1]}}-{{formData.ca_dob_y[$index+1]}}
NHS or NI No.: {{formData.ca_nhs_or_ni_no[$index+1]}}
EHIC PIN Number: {{formData.ca_ehic_pin_number[$index+1]}}

Contact information

Address Line 1: {{formData.addressline1}}
Address Line 2: {{formData.addressline2}}
Town or City: {{formData.city}}
County: {{formData.county}}
Country: {{formData.country}}
UK Postcode: {{formData.postcode}}
Phone Number: {{formData.phone}}
Email: {{formData.email}}
Registration fee: £35.00
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E111 Renewal / EHIC Renewal

The E111 renewal form used to be the way that people in the UK could prove that they were citizens of a European country, if ever they needed to receive medical treatment while abroad. If a UK citizen travelled to a country within the European Economic Area (EEA) and needed to receive medical help while there, they could simply show their E111 card renewal and receive free treatment, or a receipt that could be used to claim their money back from the NHS when they got home.

From 1st January 2006 the E111 was changed slightly and is now called an EHIC (European Health Insurance Card).

Changes to the rules mean that if you travel to an EEA country you can receive treatment as if you were a resident of that country. That might mean that you have to pay some money upfront – a contribution to your healthcare similar to a contribution you might pay in the UK for prescriptions or dental care. This is called a ‘co-payment’ and you cannot claim a refund of that co-payment when you return to the UK. However, by producing your EHIC you will be charged far, far less than if you did not, because without it you would be regarded as a non-EEA citizen and accordingly would have to pay full price. Your EHIC can therefore save you thousands of pounds and it is vital that you take it with you when you travel.

The EHIC will not cover any private medical care treatment and will not cover any medical costs incurred on cruises.

If you still have an E111 it will no longer be valid and you will need to apply instead for a new EHIC card. If you already have an EHIC but just refer to it as an E111 card, check the expiry date on your E111 card well before you travel to ensure that it is still valid for your trip. An EHIC is only valid for five years before you will need to get a renewal.

It is quick and easy to apply for an E111 renewal (in the form of an EHIC renewal). You can renew your E111 card (EHIC card) at any time in the six months before it is due to expire. Any time you have left on your existing EHIC will not be added to your new one, so will effectively be lost. When renewing your E111 card you should therefore strike a balance between applying close to its expiry date and leaving ample time to ensure you receive your new card before you travel.

Renewing your E111 card

This can be done online if your details (such as your name and address) have not changed since you last applied. You will need a PIN, which can be found on your EU Health Card. If you still have an old E111 form, you will not have a PIN and you will have to apply for your first EHIC card by way of a fresh application, rather than renewal.

If you do not have a PIN (or an existing EHIC) you will have to apply by telephone or post.

You can apply to renew your own EHIC  or E111 at any time during the six months before it expires. Any unused time will not be added to your new card – your new card will still last for five years. For instance, if you were to apply, say, four months before your E111 renewal date, your new EHIC renewal will commence on that date and last for five years, not five years and four months.

How to renew the E111 card for families

Previously, under the E111 card, all family members were covered under one form. Under the new EHIC renewal system, each member of your family will need their own EHIC, even your children.

When renewing your E111 card (EHIC) you should fill in details for all of your family members, even if some of them do not need to renew their E111 card at the same time – this is because family members are linked through the EHIC card renewal system. Only the e111 cards of those family members whose cards are due for renewal will actually be renewed when you do this.

You can renew your E111 card online if you have your PIN, which is on your existing EHIC card (but will not be found on your old E111 form). If you do not have a PIN, or if your details have changed since your last application, you will need to apply by telephone or post.

To renew your E111 card to make it valid for a planned trip, apply in good time and ensure that you take your new EHIC renewal with you when you travel. You should also take out travel insurance, as your EHIC will not cover private healthcare treatment (which often includes ambulance travel) or other costs such as theft or loss of luggage.

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