S1/E121 EHIC Renewal Application Form
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S1/E121 EHIC renewal application form
Please note: By submitting this form you are declaring that you have a valid S1/E121 which was issued to you for the country you currently reside in, due to you receiving an exportable UK benefit.
This form is only for use by people who live abroad. If you live in the UK, please visit www.nhs.uk/ehic for details of how to apply.
Name:
Title First name(s) Last name
Current address:
House name/number Street name
City County/Region Country Post code
Previous address (if different to current address):
House name/number Street name
City County/Region Country Post code
UK PIN Number (shown on your current EHIC):
UK
Are your circumstances still the same as when you last applied for your EHIC?
Yes No
v2 If your circumstances are not the same as when you last applied for your EHIC, please tell us about your change in circumstances:
Name and UK PIN of spouse/partner (if applicable):
Title First name(s) Last name
UK PIN (shown on current EHIC) UK
Name(s) of dependent children living at your address (if applicable):
UK PIN (shown on Title First name(s) Last name current EHIC) UK UK UK UK UK
You can only use this form to renew your EHIC via email - please attach to your email and send to: [email protected]. We are unable to accept this form by fax or post.