Online EHIC Application Form

Just complete this form, make your payment online, and leave the rest to us:

Personal information  
Title *
Family name *
First (given) name *
Birth date * (DD/MM/YYYY)
NHS or NI No.*
EHIC PIN Number (Only for Renewals)
Are you planning to permanently live outside the UK after this visit? * Yes     No
If Yes, enter expected departure date.
Contact Details  
House Name or Number *
Street *
Town *
County *
Postcode *
Country *
E-mail address *
Please re-enter your E-mail address *
Telephone no. *
Add details for Spouse/Partner YES   NO

Add details for First Child YES   NO

Add details for Second Child YES   NO

Add details for Third Child YES   NO

Add details for Fourth Child YES   NO

Declaration:
  • I agree that I have British, EU, EEA or Swiss nationality.
  • I agree that all persons to be specified in this application are UK residents.
  • I declare that the persons named have consented to their personal details being disclosed.
  • I declare that the Main Applicant is 16 years or over.
  • The information that I have given on this form is correct and complete to the best of my knowledge.
  • 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.
  • I understand that this card is not an entitlement card for NHS services, or proof of identity.
I have read and agree to the above Declaration and the Terms & Conditions *
YES
Please select service level required *
EXPRESS
(Processed immediately, allow 7-10 days delivery - £39.99)
STANDARD
(Processed within 24 hours, allow 2 weeks delivery - £22.99)
Click on the button opposite to send the form. You will then be taken to the payment section.