Application Form

You can save on postage

by applying online at
www.ceacard.co.uk

Please complete in ink using BLOCK CAPITALS

Type of Application
Please tick one of the following:
First application for a CEA Card?

Renewal of an expired CEA Card?

If this is a renewal application and you have recently received a reminder letter
then please enter the reminder reference number here:
Replacement of a current CEA Card that has been lost or stolen?
Applicant Details
The applicant is the person requiring assistance at the cinema and not the person
providing assistance or completing this form.
Forename:
Surname:
Address:

Town/City:

Postcode:

Please enter an email address if you would like us to keep you updated on the
status of this application and to remind you when the card is due for renewal. We
will also be able to let you know about any changes to the card scheme.
Email:
Please enter daytime contact number(s):
Telephone:

Mobile:

Minicom:
Applicant Photo
To enable easy checking at the cinema please provide a
passport-sized colour photograph that is an accurate and
recent likeness of the applicant. If this application is for a
renewal or replacement card then we can use the current
CEA Card photo if it is still a good likeness. Please write
the applicants name on the back of the photo.
I authorise the use of my current CEA Card photo.
Form D0527_3.0

Affix Photo

Proof of Eligibility
Please enclose proof of eligibility that clearly demonstrates one of the following:

Disability Living Allowance.

Attendance Allowance.
Blind Persons Registration.
Personal Independence Payment.
Armed Forces Independence Payment.

If you are sending original documents that you would like returned, then please
enclose a stamped self-addressed envelope (SAE) for their return. Documents
received without a return request or SAE will be securely shredded.
I have enclosed a SAE. Please return my original documents.
Terms and Conditions
Please confirm that the applicant is 8 years of age or older.
Please tick here if you would like us to contact you by email with additional
information and offers from cinemas.
Please tick here to confirm you agree to the CEA Card terms and conditions.
These can be viewed on our website www.ceacard.co.uk.
Payment of Processing Fee
6.00 payment by cheque or postal order only made payable to: CEACARD.
Application Checks
Before posting this application form please check the following points:

The applicants name and address details are correct and complete.
The applicants photo is attached or use of the existing one is authorised.
The applicants document providing proof of eligibility is attached.
A Cheque or Postal Order payment for 6.00 is enclosed.
A stamped SAE is enclosed for return of eligibility documents (if applicable).
The correct postage has been applied to the envelope.

ONLY tick here if you will need a Braille label on your card.
Please post your application to
CEA Card, PO Box 212, Waterlooville, PO7 6ZN
For further information please visit www.ceacard.co.uk or contact our help desk:
Telephone: 023 9224 8545 Textphone: 18001 023 9224 8545
Email: info@ceacard.co.uk
Form D0527_3.0