FrancophonIA/DGT-Translation_Memory huggingface dataset:
English: DE = Germany; EE = Estonia; GR = Greece; ES = Spain; FR = France; IE = Ireland; IT = Italy; CY = Cyprus; LV = Latvia; LT = Lithuania; LU = Luxembourg; HU = Hungary; MT = Malta; NL = Netherlands; AT = Austria; PL = Poland; PT = Portugal;
Polish: ES = Hiszpania; FR = Francja; IE = Irlandia; IT = Włochy; CY = Cypr; LV = Łotwa; LT = Litwa; LU = Luksemburg; HU = Węgry; MT = Malta; NL = Niderlandy;
Latvian: DE = Vācija, EE = Igaunija, GR = Grieķija, ES = Spānija, FR = Francija, IE = Īrija, IT = Itālija, CY = Kipra, LV = Latvija, LT = Lietuva, LU = Luksemburga, HU = Ungārija, MT = Malta, NL = Nīderlande, AT = Austrija, PL = Polija, PT = Portugāle,
English: all documents proving the family relationship or relationship through marriage with the deceased or, where appropriate, cohabitation with the deceased;
Portuguese: qualquer documento comprovativo do grau de parentesco ou afinidade com a pessoa falecida ou, se for o caso, da coabitação com a mesma;
Latvian: visi dokumenti, kas apliecina ģimenes attiecības vai laulības attiecības, vai, ja vajadzīgs, kopdzīvi ar mirušo personu;
English: certificate attesting to the family relationship, or receipted bills for funeral expenses if the claimant has no family relationship with the deceased;
Latvian: apliecība, kas apliecina radniecību, vai kvitēti rēķini par apbedīšanas izdevumiem, ja pieprasītājam nav radniecības ar mirušo personu
English: It may not be used instead of another form. Please complete this form in block letters, writing on the dotted lines only.
Dutch: formulieren is voorzien; dit formulier kan geen enkel ander formulier vervangen.
English: It consists of four pages, none of which may be left out. Part A 1.
Dutch: Dit formulier, bestaande uit 4 bladzijden, moet in blokletters worden ingevuld.
Polish: Proszę wypełnić formularz drukowanymi literami, wpisując dane wyłącznie w miejscach wykropkowanych.
Slovenian: Obrazec obsega 4 strani, od katerih ne sme nobena manjkati.
English: Please give as much information as possible to facilitate identification of the employer or the firm of the self-employed person. In the case of a ship, indicate its name and its registration number.
Dutch: Vermeld zo veel mogelijk gegevens aan de hand waarvan de werkgever of het bedrijf van de zelfstandige kunnen worden geïdentificeerd.
English: Identification number of the institution: …. 1.3
Dutch: Identificatienummer van het orgaan: …
Slovak: Identifikačné číslo inštitúcie: …
English: Country: … 4.2
Portuguese: País: …
Dutch: Land: …
Polish: Państwo: …..
English: Please state as much information as possible which may be used in order to identify the employer or the firm of the self-employed person. In the case of a ship indicate the name of the ship and the ship registration number.
Dutch: Vermeld zo veel mogelijk gegevens aan de hand waarvan de werkgever of het bedrijf van de zelfstandige kunnen worden geïdentificeerd.
English: Surname(s) (3) Forename(s) (4)
Dutch: Familienaam/-namen (3)
English: Previous name(s) Date of birth
Dutch: Voornaam/-namen (4)
English: Last employer (5) Last activity as a self-employed person (5) 3.1
Dutch: Laatste werkgever (5) Laatste werkzaamheid als zelfstandige (5)
English: have been awarded have not been awarded 6.1 in accordance with Article
Portuguese: As prestações em espécie foram concedidas não foram concedidas
Dutch: De verstrekkingen zijn toegekend zijn niet toegekend
English: The claimant has not worked again up to now
Portuguese: exerceu a actividade seguinte:
Dutch: heeft de volgende werkzaamheid uitgeoefend:
English: Identification number of the institution: … 5.3
Dutch: Identificatienummer van het orgaan: …
Swedish: Institutionens identifieringsnummer: …
Polish: Numer identyfikacyjny instytucji: …
Slovenian: Identifikacijska številka nosilca: …
English: Identification number of the institution: … 8.3
Dutch: Identificatienummer van het orgaan: …
Swedish: Institutionens identifieringsnummer: …
Polish: Numer identyfikacyjny instytucji: …
English: The competent institution should complete part A of the form and issue two copies to the insured person or send them, where necessary through the liaison body, to the institution in the place of residence if the form has been drawn up at that institution's request.
Dutch: Het bevoegde orgaan vult deel A van het formulier in en reikt twee exemplaren daarvan uit aan de verzekerde of zendt deze (eventueel via het verbindingsorgaan) naar het orgaan van de woonplaats, indien het formulier op verzoek van dit orgaan is ingevuld.
English: Where the members of the insured person's family are resident in the United Kingdom, the competent institution should send the two copies to the Department for Work and
Dutch: Indien de gezinsleden van de verzekerde in het Verenigd Koninkrijk wonen, zendt het bevoegde orgaan beide exemplaren naar het Department for Work and Pensions, Pension Service, International Pension Centre, Tyneview Park, Newcastle upon Tyne.
English: Pensions, Pension Service, International Pension Centre, Tyneview Park, Newcastle upon-Tyne. On receipt of the txo copies, the institution of
Dutch: Het orgaan van de woonplaats vult na ontvangst van beide exemplaren deel B in en zendt een exemplaar aan het bevoegde orgaan terug.
Slovak: (Ministerstvo práce a dôchodkov, sekcia pre dôchodky, medzinárodné stredisko pre dôchodky), Tyneview Park, Newcastle upon Tyne. Keď
English: the place of resistence should complete part B and return one copy to the competent institution. Where the members of the family are resident in
Dutch: Wanneer de gezinsleden niet allen in hetzelfde land wonen, moet voor elk land een verklaring worden opgesteld.
English: Stamp 8.5 Date: ….
Dutch: Stempel 8.5 Datum: …
Slovak: Pečiatka 8.5 Dátum: …
Polish: Pieczęć 8.5 Data: …
English: Family member of the insured person Self-employed worker
Dutch: steeds compleet zijn, ook wanneer een bladzijde niet is ingevuld.
English: Family member of a pensioner (employed worker) Pensioner (self-employed worker)
Dutch: pensioengerechtigde (werknemer) gezinslid van een pensioengerechtigde (werknemer)
English: The person referred to above is authorised to retain the right to benefits in kind from sickness and maternity insurance
Portuguese: A pessoa acima mencionada está autorizada a conservar o direito às prestações em espécie
Dutch: Genoemde persoon werd toestemming verleend het recht op verstrekkingen te behouden
English: Address: ….… ….
Dutch: Adres: ….… ….
English: Will you please let us know if you agree to this procedure and, if so, give us all information necessary for the payment of the benefits. (8) 10.
Dutch: Gelieve ons te berichten of u het met deze procedure eens bent, en ons in dat geval de nodige gegevens voor de uitbetaling te verschaffen (8).
English: Please complete this form in block letters, writing on the dotted lines only. The form consists of three pages. 1. Competent institution to which the form is addressed 1.1 Name: ….. 1.2 Identification number of the institution: ….…
Portuguese: O formulário deve ser preenchido em caracteres de imprensa, utilizando apenas as linhas pontilhadas.
Dutch: formulier te voegen (2).
English: The examination carried out by our doctor on …. (date)
Dutch: Uit het door onze geneesheer verrichte onderzoek op … (datum)
Swedish: Den undersökning som utfördes av vår läkare den … (datum)
Slovak: Z vyšetrenia, ktoré vykonal náš lekár dňa … (dátum)
English: Address: ….….. …... 4.4 Stamp 4.5 Date: …
Dutch: Stempel 4.5 Datum: …
Slovak: Pečiatka 4.5 Dátum: …
English: Identification number of the investigating institution: .… 6.2
Portuguese: Número de identificação da instituição de instrução: ..…
Dutch: Identificatienummer van het behandelende orgaan: .….
Slovak: Identifikačné číslo inštitúcie, ktorá prípad prešetruje: …
Polish: Numer identyfikacyjny instytucji rozpatrującej: …
Slovenian: Identifikacijska številka nosilca, ki primer obravnava: …
English: Please complete this form in block letters, writing on the dotted lines only. The form consists of three pages. 1. Institution of the place of residence or stay (2) 1.1 Name: …..….. 1.2 Identification number of the institution: ….…..
Dutch: moet het aan bedoeld orgaan worden toegezonden; in andere gevallen moet het aan de verzekerde worden uitgereikt.
English: inIceland, the ‘Tryggingastofnun rikisins’ (The State Social Security Institute), Reykjavik; inLiechtenstein,the Office of National Economy;
Dutch: inLiechtenstein, het „Amt für Volkswirtschaft” (Bureau voor de nationale economie), Vaduz;
English: divorced 1.2
Portuguese: divorciado(a)
Dutch: gescheiden
Swedish: frånskild
English: ….. from …..
Dutch: van … t/m … …
English: each pensioner and each member of the family of a pensioner. 1.
Dutch: pensioengerechtigde en voor ieder gezinslid van een pensioengerechtigde een apart formulier invullen.
English: (from … to … ) 6.1
Portuguese: (de … a … )
Dutch: (van … tot en met … ),
Swedish: (fr.o.m. …. t.o.m. …..)
Slovak: Adresa: … …..
English: Address: … …. 2.
Polish: Nazwa instytucji: …
English: Country: … 6.4
Polish: Państwo: …
Slovenian: Država: …
English: Nationality: ….….…
Polish: … …
English: by the diplomatic mission or consulate post named hereafter: …..….
Polish: wymienionej poniżej: …
English: of the State to whose legislation he was last subject, i.e. the legislation of Belgium
Polish: państwa, którego ustawodawstwu ostatnio podlegałem/podlegałam, tzn. ustawodawstwu
English: Czech Republic Denmark
Polish: Belgii Republiki Czeskiej Danii Niemiec Estonii
English: Germany Estonia Greece Spain France Ireland Italy Cyprus Latvia
Polish: Grecji Hiszpanii Francji Irlandii Włoch
English: Lithuania Luxembourg Hungary Malta
Polish: Grecji Hiszpanii Francji Irlandii Włoch
English: Netherlands Austria Poland
Polish: Malty Niderlandów Austrii Polski Słowenii
English: Slovenia Portugal
Polish: Portugalii Słowacji Finlandii Szwecji Zjednoczonego Królestwa
English: Slovakia Finland
Polish: Islandii Liechtensteinu Norwegii Szwajcarii
English: Sweden United Kingdom
Polish: Malty Niderlandów Austrii Polski Portugalii
English: Signature: …..… 6.
Polish: Organ Wspólnot Europejskich, który zawarł umowę z członkiem personelu pomocniczego
English: …..… 6.3 Stamp 6.4
Polish: Pieczęć 6.4 Data: …
English: We have taken note of the fact that the person mentioned in box 1 is subject to the legislation of (6) Belgium
Polish: Przyjmujemy do wiadomości, że pracownik wymieniony w punkcie 1 podlega ustawodawstwu (6)
English: Czech Republic Denmark Germany Estonia Greece Spain France Ireland Italy Cyprus Latvia
Polish: Belgii Republiki Czeskiej Danii Niemiec Estonii
English: Netherlands Austria Poland Portugal Slovenia Slovakia Finland
Polish: Cypru Łotwy Litwy Luksemburga Węgier
English: Iceland Liechtenstein
Polish: Słowenii Słowacji Finlandii Szwecji Zjednoczonego Królestwa
English: Norway Switzerland
Polish: Islandii Liechtensteinu Norwegii Szwajcarii
English: Stamp 7.5 Date: …... 7.6 Signature: ….. B. Notification of registration (9) 8. 8.1 The insured person named in box 2 and the members of his family 8.2 The members named in box 3 of the family of the unemployed person 8.3 were registered with us on … 8.4 cannot be registered with us because … ….. 9. 9.1 Surname(s) (3) Forename(s) (4) Previous name(s) Date of birth Personal identification number 9.2 … ….. … …. …. 9.3 … ….. … …. …. 9.4 … ….. … …. ….
Polish: Pieczęć 7.5 Data: …
English: inSweden, ‘Försäkringskassan (Local Social Insurance Office) in the place of residence in theUnited Kingdom, the Department for Work and Pensions, the Pension Service, International Pension Centre, Tyneview Park,
Swedish: Storbritannien och Nordirland:Department for Work and Pensions, the Pension Service, International Pension Centre, Tyneview Park,
Polish: (Ministerstwo Pracy, Emerytur i Rent , Centrum Emerytalno-Rentowe, Centrum ds. Świadczeń Zagranicznych), Tyneview Park, Newcastle-upon-Tyne lub dla Irlandii Północnej: „Department for Social Development, Overseas Benefits Branch” (Ministerstwo Rozwoju Społecznego
English: Stamp 9.5
Swedish: Stämpel
Polish: Pieczęć
English: Date: … 9.6
Polish: Data:
English: Pension Claimant 2.1
Portuguese: Requerente de pensão ou de renda
Polish: Osoba ubiegająca się o emeryturę/rentę
English: died on …. (date) 4.5
Polish: zmarł dnia … (data)
English: Date: … 5.6
Polish: Pieczęć 5.5 Data: …
Slovenian: Datum: …
English: Date: … 8.6
Polish: Pieczęć 8.5 Data: …
Slovenian: Datum: …
English: It consists of two pages, none of which may be left out. 1.
Polish: Proszę wypełnić formularz drukowanymi literami, wpisując dane wyłącznie w miejscach wykropkowanych.
English: Insured person Family member of the insured person
Polish: Formularz składa się z 2 stron, z których żadna nie może zostać pominięta.
English: Stamp 4.5
Slovak: Pečiatka
Polish: Pieczęć
English: The address of the Social Insurance Agency HQ is: Sociálna poist'ovňa, ústredie, ul. 29. augusta č.
Polish: Adres Centrali Urzędu Zabezpieczenia Społecznego: Sociálna poist'ovňa, ústredie, ul. 29. augusta č.
English: 8–10, 813 63 Bratislava 1.
Polish: 8–10, 813 63 Bratysława 1.
Slovenian: 813 63 Bratislava 1.
English: The person indicated in section 2 and the members of his family were registered on …(date) 9.
Polish: Osoba wskazana w sekcji 2 i członkowie jej rodziny zostali zarejestrowani w dniu … (data)
English: Date of birth Personal identification number F M 9.2
Polish: Zarejestrowani członkowie rodziny
English: ….…... … …..….
Polish: Nazwisko(-a) (3)
English: ….….. ….…... … …..….
Polish: Imię/Imiona
English: ….….. 9.3
Polish: Płeć
English: ….…... … …...
Polish: Data urodzenia
English: …..….. ….…... …
Polish: Osobisty numer identyfikacyjny
English: ….…... …. …..….
Polish: … … … …
English: … ….…... … …..…. … 9.5 …..….. … ..….
Polish: … … … …
English: … …..…... …
Polish: … … … …
English: …..…. … 9.6 …..….. … …..….
Polish: … … … …
English: … ….…... …
Polish: … … … …
English: … 9.7 …..….. … …..….
Polish: … … … …
English: … ….…... … ..…. … 9.8 …..….. … …..….
Polish: … … … …
English: … ….…... … …..….
Polish: … … … …
English: is not a legal person under private law who, on the basis of an insurance contract, has covered some or all of the costs (6)
Polish: osobą prawną podlegającą prawu prywatnemu, która, na podstawie umowy ubezpieczeniowej, pokryła częściowo lub całkowicie koszty (6)
English: Internal Affairs and Administration — liaison body for special schemes); inPortugal, for metropolitan Portugal: the ‘Centro Distrital de Solidariedade e Segurança Social’ (Regional Centre for Solidarity and Social
Polish: wPortugalii, w części kontynentalnejdo„Centro Distrital de Solidariedade e Segurança Social” (Regionalne Centrum Solidarności i Zabezpieczenia
English: a frontier worker (self employed) an unemployed worker
Polish: pracownikiem przygranicznym (prowadzącym działalność na własny rachunek)
English: Hospitalisation from …..
Polish: Hospitalizacja od ….
English: Please complete this form in block letters, writing on the dotted lines only. It consists of four pages, none of which may be left out.
Portuguese: O formulário deve ser preenchido em caracteres de imprensa, utilizando apenas as linhas pontilhadas.
English: Address: … …. 2. Information concerning the insured person (2) 2.1
Portuguese: Número de identificação da instituição: …
Slovenian: Identifikacijska številka nosilca: ….…
English: Identification number (6): …..
Portuguese: Número de identificação (6): …
English: Social Security Conventions), Lisbon; inSlovenia, to the competent regional unit of the the ‘Zavod za zdravstveno zavarovanje Slovenije (ZZZS)’ (Health Insurance Institution of
Portuguese: naEslovénia, à delegação regional competente do «Zavod za zdravstveno zavarovanje Slovenije (ZZZS)» (Instituto do Seguro de Doença
English: …..… 2.
Portuguese: …..…
Swedish: …..…
Slovenian: …..…
English: accident at work occupational disease 2.7
Portuguese: acidente de trabalho doença profissional
English: in box 2 in box 4
Portuguese: no quadro 2 no quadro 4
English: Competent institution 11.1
Portuguese: Instituição competente
English: they are pursuing a professional activity or trade (5) 5. This entitlement begins on …..….
Portuguese: exercerem uma actividade profissional (5)
English: Address: ….…..….. …
Portuguese: É composto de 3 páginas.
English: Unemployed person 3.1
Portuguese: Trabalhador desempregado
English: E 118 form to take an appealable decision within a reasonable period of time. The method of appealing and the time limit within which to appeal
Portuguese: quadro 4 do formulário E 118) que tome uma decisão susceptível de recurso num prazo razoavelmente curto.
English: Personal identification number F
Portuguese: Número de identificação pessoal
English: inSpain,the ‘Dirección Provincial del Instituto Nacional de la Seguridad Social’ (Provincial Directorate of the National Social Security Institution) at the place of residence or stay.
Portuguese: emEspanha, a «Dirección Provincial del Instituto Nacional de la Seguridad Social» (Direcção Provincial do Instituto Nacional da Segurança Social) do lugar de residência ou de estada.
English: inHungary, the competent ‘Megyei Egészségbiztosítási Pénztár’ (regional sickness insurance fund); inMalta,the Ministry of Health, Valetta;
Portuguese: naHungria, o «Megyei Egészségbiztosítási Pénztár" (Caixa Regional do Seguro de Doença) competente;
English: Social Security) of the place of residence; for Madera: the ‘Centro de Segurança Social da Madeira’ (Madeira Social Security Centre), Funchal; for the Azores: the ‘Centro de Prestações Pecuniárias’ (Centre for Cash Benefits) of the place of residence;
Portuguese: emPortugal, para oContinente: o Centro Distrital de Segurança Social do lugar de residência; para a Madeira: o Centro de Segurança Social da Madeira, no Funchal; para os Açores: o Centro de Prestações Pecuniárias para o lugar de residência;
English: …..….. 5.3
Portuguese: …..…..
Swedish: …..…..
English: was not dependent on me 6.
Portuguese: não estava a cargo do requerente do subsídio
Slovak: nebol závislý od žiadateľa
English: Agriculture —KRUS), the ‘Zaklad Emerytalno-Rentowy Ministerstwa Spraw Wewnetrznych i Administacji’ (Pensions Office of the Ministry of Internal Affairs and Administration — liaison body for special schemes);
Portuguese: (Fundo de Seguro Social Agrícola), o «Zaklad Emerytalno- Rentowy Ministerstwa Spraw Wewnetrznych i Administacji» (Serviço de Pensões
Swedish: regionalkontoret för Kasa Rolniczego Ubezpieczenia Spolecznego (KRUS), Zaklad Emerytalno-Rentowy Ministerstwa Spraw Wewnetrznych
Slovak: v Portugalsku,ak ide o kontinentálne Portugalsko,„Centro Distrital de Solidariedade e Segurança Social“(Oblastné stredisko solidarity a
English: Security) of the place of residence; for Madera: the ‘Centro de Segurança Social da Madeira’ (Madeira Social Security Centre), Funchal; for the Azores: the ‘Centro de Prestações Pecuniárias’ (Centre for Cash Benefits) of the place of residence;
Portuguese: emPortugal, para o Continente: o Centro Distrital de Segurança Social do lugar de residência; para a Madeira: o Centro de Segurança Social da Madeira, no Funchal; para os Açores: o Centro de Prestações Pecuniárias para o lugar de residência;
English: Medical treatment …..
Portuguese: Cuidados médicos …..
English: Dental treatment …..
Portuguese: Cuidados dentários …..
English: Other benefits (6) …..
Portuguese: Outras prestações (6) …..
English: Medical examinations (7) …..
Portuguese: Inspecções médicas (7) …..
English: For cash benefits provided from …..
Portuguese: Por prestações pecuniárias de ..…. a …..
Slovenian: Za denarna nadomestila, zagotovljena od: … do: …..
English: and Social Security Conventions), Lisbon; inSlovenia,the ‘Zavod za zdravstveno zavarovanje Slovenije-Direkcija’ (Health Insurance Institute of Slovenia-Directorate), Ljubljana;
Portuguese: naEslovénia, o «Zavod za zdravstveno zavarovanje Slovenije Direkcija» (Instituto de Seguro de Doença da Eslovénia — Direcção), em Ljubljana;
English: Model form E 102 reproduced in Decision No 164 is replaced by the model appended hereto. 3. Model form E 105 reproduced in Decision No 153 is repealed.
Slovak: Vzorové tlačivo E 102 priložené k rozhodnutiu č. 164 sa nahrádza vzorom, ktorý je prílohou k tomuto rozhodnutiu.
English: Reasons: …...… …..…..
Slovak: Dôvody: …
English: For the purpose of Spanish institutions in the case of Spanish nationals state the number appearing on the national identity card (DNI) or NIE in the case of foreign people, for both cases if it exists, even if the identity card is out of date.
Slovak: Na účely španielskych inštitúcií a v prípade štátnych príslušníkov Španielska uveďte číslo z preukazu štátneho občianstva (DNI), alebo ak ide o cudzincov, N.I.E., v oboch prípadoch, ak existuje, aj keď je tento preukaz už neplatný.
English: For the purpose of Italian institutions, give the "fiscal code". For the purpose of Maltese institutions, give the Identity Card number in case of Maltese nationals, or the Maltese Social security number in case of a non-Maltese national. For the purpose of Slovak institutions, give the Slovak birth number if applicable.
Slovak: Na účely talianskych inštitúcií uveďte "fiškálny kód".
English: if so, give the name … and
Slovak: … a
English: Fax: …..… Street: …..
Slovak: Ulica: … Č.: … P. O. Box: …
English: Employed person Self-employed person 2.1
Slovak: Meno/á (4): …
English: Nationality: …..
Slovak: Ulica: … Č.: … P. O. Box: …
English: PO Box: …. Town: … Postcode: ….. Country: … 2.6
Slovak: bol vyslaný
English: Personal identification number (5): … 3. The abovementioned insured person has been posted is carrying out an activity as a self-employed person in accordance with Article: 3.1 14(1)(a) 14a(1)(a) 14b(1)
Slovak: vykonáva činnosť ako samostatne zárobkovo činná osoba v súlade s článkom:
English: 14b(2) of Regulation (EEC) No 1408/71 3.2 for the period from …. to … 3.3 to/in the undertaking(s) specified below to/on the ship specified below 3.4
Slovak: 14 ods. 1 písm. a) 14 ods. 1 písm. a) 14b ods. 1 14b ods. 2 nariadenia (EHS) č. 1408/71
English: Name of firm or ship …..
Slovak: od … do …
English: Postcode: …. Country: … 3.6
Slovak: Mesto: … PSČ: … Štát: …
English: Street: … No: …..
Slovak: Ulica: … Č.: … P. O. Box: …
English: PO Box: … Town: … Postcode: …. Country: … 4.2
Slovak: Mesto: … PSČ: … Štát: …
English: Postcode: …. Country: … 8.4 Stamp 8.5 Date:
Slovak: Pečiatka 8.5 Dátum:
English: Address: … …
Slovak: Adresa: …
English: If that institution considers it is unable to send the requested form, it should complete part B and return one of the two copies to the institution from which it received them.
Slovak: Ak sa táto inštitúcia domnieva, že požadovaný formulár nemôže zaslať, vyplní časť B a jednu z dvoch kópií vráti
English: issued under the legislation of the competent State) Valid from … to ….
Slovak: s platnosťou od … do …
English: Pensioner (scheme for self-employed person) Pension Claimant
Slovak: Dôchodca (systém pre samostatne zárobkovo činné osoby)
English: …... …. …
Slovak: … … … …
English: … … 9.8
Slovak: už im vznikol nárok na vecné dávky
English: ….. … … … Because
Swedish: … … … …
Slovak: Priezviská (3) Mená (4) Dátum narodenia Osobné identifikačné číslo
English: …... … …. …. 10.3 …... … … …. 10.4 …... … …. …. 10.5 …... … … …. 10.6
Slovak: … … … …
English: from non-occupational accident insurance (5) in … (country), where he/she is going
Slovak: v … … (štáte), kam vycestuje
English: having examined the person mentioned above on …
Slovak: dňa …
English: Clinical examination: ….. …
Slovak: Klinické vyšetrenie: …
English: Other observations: … …
Slovak: Iné zistenia: …
English: Diagnosis: …. …
Slovak: Diagnóza: …
English: The person concerned has been found to be unfit for work from …. to ….…..
Slovak: od … do …
English: The person concerned has been found partly unfit for work to a degree of (… %) from …... to …. (5)
Slovak: (… %) od … do … (5)
English: at the doctor's surgery in hospital
Slovak: v zariadení ústavnej zdravotnej starostlivosti
English: … Surname(s) at birth (if different):
Slovak: Rodné priezvisko/á, ak sa odlišuje/ú: …
English: decision to: Name: ….…..
Slovak: Názov: …
Slovenian: Ime: …
English: augusta č. 8–10, 813 63 Bratislava 1.
Slovak: augusta č. 8 – 10, 813 63 Bratislava 1.