<p>S1/E121 EHIC renewal application form</p><p>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.</p><p>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. </p><p>Name: </p><p>Title First name(s) Last name</p><p>Current address: </p><p>House name/number Street name</p><p>City County/Region Country Post code</p><p>Previous address (if different to current address): </p><p>House name/number Street name</p><p>City County/Region Country Post code</p><p>UK PIN Number (shown on your current EHIC):</p><p>UK</p><p>Are your circumstances still the same as when you last applied for your EHIC?</p><p>Yes No</p><p> v2 If your circumstances are not the same as when you last applied for your EHIC, please tell us about your change in circumstances:</p><p>Name and UK PIN of spouse/partner (if applicable):</p><p>Title First name(s) Last name</p><p>UK PIN (shown on current EHIC) UK</p><p>Name(s) of dependent children living at your address (if applicable):</p><p>UK PIN (shown on Title First name(s) Last name current EHIC) UK UK UK UK UK</p><p>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.</p>