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e Full name;

Date and place of birth;

Citizenship;

© Country of permanent residence;

© U.S. and/or Swedish Social Security number

© Name and relationship of family members accompanying you;
© Address in Sweden, if known;

© Nature of self-employment activity;

© Dates the activity was or will be performed; and

« Name and address of your trade or business in both countries.

Effective Date Of Coverage Exemption

The certificate of coverage you receive from one country will show the effective date of your exemption from paying Social Security
taxes in the other country. Generally, this will be the date you began working in the other country.

Certificates of coverage issued by Sweden should be retained by the employer in the United States in case of an audit by the
Internal Revenue Service (IRS). No copies should be sent to IRS unless specifically requested by IRS. However, a self-employed
person must attach a photocopy of the certificate to his or her income tax return each year as proof of the U.S. exemption.

Copies of certificates of coverage issued by the United States will be provided for both the employee and the employer. It will be
their responsibility to present the certificate to the Swedish authorities when requested to do so. To avoid any difficulties, your
employer (or you, if you are self-employed) should request a certificate as early as possible, preferably before your work in the
other country begins.

If you or your employer request a certificate of coverage, you should read the Privacy Act and Paperwork Reduction Act statements
below.

Authority to collect iInformation for a certificate of coverage
Privacy Act

|The Privacy Act requires us to notify you that we are authorized to collect this information by section 233 of the Social Security Act.

hile it is not mandatory for you to furnish the information to the Social Security Administration (SSA), a certificate of coverage
cannot be issued unless a request has been received. The information is needed to enable SSA to determine if work should be
covered only under the U.S. Social Security system in accordance with an international agreement. Without the certificate, work
Imay be subject to taxation under both the U.S. and the foreign Social Security systems.

Paperwork Reduction Act Notice

[This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork

Reduction Act of 1995. You are not required to answer these questions unless we display a valid Office of Management and Budget

(OMB) control number. We estimate that it will take you about 30 minutes to read the instructions, gather the necessary facts, and
rite down the information to request a certificate of coverage.

Monthly benefits

The following table shows the various types of Social Security benefits payable under the U.S. and Swedish Social Security systems
and briefly describes the eligibility requirements that normally apply for each type of benefit. If you do not meet the normal
requirements for these benefits, the agreement may help you to qualify (see "How benefits can be paid" section).

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Payment Of Benefits

Each country pays its own benefit. U.S. payments are made by the U.S. Department of Treasury each month and cover benefits for
the preceding month. Payments under the Swedish system are made by the National Insurance Board, generally between the 12th
and 17th of each month, and cover benefits for that month.

Absence From U.S. Territory

Normally, persons who are not U.S. citizens may receive U.S. Social Security benefits while outside the U.S. only if they meet certain
requirements. Under the agreement, however, if you are a U.S. or Swedish citizen, a refugee, a stateless person or a person who is
eligible for dependents or survivors benefits based on the Social Security record of one of these people, you may receive benefits
as long as you reside in Sweden. If you are not a U.S. or Swedish citizen and live in another country, you may not be able to receive
benefits. The restrictions on U.S. benefits are explained in the publication, Your Payments While You Are Outside The United States
(Publication No. 05-10137).

Appeals

If you disagree with the decision made on your claim for benefits under the agreement, contact any U.S. or Swedish Social Security
office. The people there can tell you what you need to do to appeal the decision.

The Swedish Social Security authorities will review your appeal if it affects your rights under the Swedish system, while U.S. Social
Security authorities will review your appeal if it affects your rights under the U.S. system. Since each country's decisions are made
independently of the other, a decision by one country on a particular issue may not always conform with the decision made by the
other country on the same issue.

For more information
To file a claim for U.S. or Swedish benefits under the agreement, follow the instructions in "Claims for benefits" section.

To find out more about U.S. Social Security benefits or for information about a claim for benefits, contact any U.S. Social Security
office. If you live outside the United States, write to:

Social Security Administration
O1lO—Totalization

P.O. Box 17769

Baltimore, Maryland 21235-7769
USA.

For more information about Sweden's Social Security programs, visit any Social Security office in Sweden. If you don't live in
Sweden, write to:

Pensionsmyndigheten

Box 855

SE-971 26 Lulea

SWEDEN

Telephone from abroad: + 46 498 200 700
E-mail: international@pensionsmyndigheten.se

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with fewer than 30 years of work.

Family benefits to dependents of retired or disabled people

United States

Sweden*

Spouse-Full benefit at full retirement age Spouse-No provision. However, a means-

or at any age if caring for the worker's
entitled child under age 16 (or disabled
before age 22). Reduced benefit as early
as age 62 if not caring for a child.
Divorced Spouse-Full benefit at full
retirement age. Reduced benefit as early
as age 62. Must be unmarried and have
been married to worker for at least 10
years.

Children-If unmarried, up to age 18 (age

19 if in an elementary or secondary school

tested wife’s supplement to the basic
pension may be payable for a wife who is
at least age 60. Certain residence
requirements may apply.

Divorced Spouse-No provision.

Children-No provision.

full time) or any age if disabled before age

22.

Survivors benefits

United States
Widow-Full benefit at full retirement age
or at any age if caring for the deceased's
entitled child under age 16 (or disabled
before age 22). Reduced benefit as early
as age 60 (or age 50 if disabled) if not
caring for child. Benefits may be
continued if remarriage occurs after age
60 (or age 50 if disabled).

Widower-Same as widow .
Divorced widow-Same as widow if
marriage lasted at least 10 years.

Divorced widower-Same as divorced
widow.

Children-Same as for children of retired
or disabled worker.

https:/www.ssa.gov/international/Agreement_Pamphlets/sweden.html

Sweden*
Widow-(worker died prior to 1/1/90 or
widow born in 1944 or earlier)-

Basic: Pension at any age if child under
age 16 in care or at least age 36 and
married at least five years.

ATP: Pension at any age if worker was
receiving ATP retirement or disability
pension, or had at least three years of ATP
coverage. Marriage must have lasted five
years and taken place before worker
reached age 60, unless there is a surviving
child of the marriage.

Widower-No provision.
Divorced widow-Same as widow if
worker died prior to 1/1/90.

No provision if worker died 1/1/90 or
later.

Divorced widower-No provision.

Children-

Basic: Under age 18, or age 20 if student.
Certain residence requirements may

apply.

ATP: Under age 18, age 20 if student.
Deceased must have had at least three
years ATP coverage. No nationality or
residence requirements.

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Sweden has a new pension system that covers people born in 1938 or later. People born in 1937 or earlier will continue to receive

their benefits only under the old system. People born between

1938 and 1953 will receive part of their benefits under the old

system and part under the new system. People born in 1954 or later will receive their benefits only under the new system.

Since the new system applies only partially to people retiring today, the following table only explains the eligibility requirements for

Swedish benefits under the old system. Under the old system, Sweden pays benefits through a two-tier program: the first tier pays

a basic pension based on residence; and the second tier pays ai

in earnings-related supplementary pension (ATP).

Under U.S. Social Security, you may earn up to four credits each year depending on the amount of your covered earnings. The

amount needed to earn a work credit goes up slightly each year. For more information, see How You Earn Credits (SSA Publication

No. 05-10072).

You can get more specific information about U.S. benefits here

on our web site or at any U.S. Social Security office or by calling our

toll-free number at 1-800-772-1213. You can get more detailed information about the old and new Swedish systems by writing to

the Swedish address in "For more information" or by visiting the Swedish National Social Insurance Board's web site at www.rfv.se.

Monthly Benefits And Eligibility Requirements

Retirement or old-age benefits

United States
Worker-Full benefit at full retirement a
or reduced benefit as early as age 62.

Sweden*
ge, Worker-

Required work credits range from one and Basic: Full pension at age 65, or reduced

one-half to 10 years (
or later).

Disabi
United States

10 years if 62 in 1991 Pension as early as age 60. Payable to

Swedish residents with three years
residence in Sweden or three years of ATP
coverage.

Payable outside Sweden to Swedish
nationals with at least three years of ATP
coverage.

ATP: Full pension at age 65; reduced
pension as early as age 60. At least three
years of work required. Reduced
payments with fewer than 30 years of
work. No nationality or residence
requirements.

ility benefits
Sweden*

Worker-Under full retirement age can get Worker-

benefit if unable to do any substantial
gainful work for at least a year. One an
one-half to 10 years credit

needed, depending on age at date of
onset. Some recent work credits also
needed unless worker is blind.

https:/www.ssa.gov/international/Agreement_Pamphlets/sweden.html

d Basic: Must be age 16 to age 65 and at
least 25 percent disabled. Payable to
Swedish residents with three years
residence in Sweden or three years of ATP
coverage.

Payable outside Sweden to nationals with
at least three years of ATP coverage.

ATP: Same as basic pension except three
years work required. Reduced payments

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A Swedish "ATP" pension may affect your U.S. benefit

If you qualify for Social Security benefits from the United States based only on U.S. credits and an "ATP" pension from Sweden
based only on Swedish ATP credits, the amount of your U.S. benefit may be reduced. This is a result of a provision in U.S. law that
can affect the way your benefit is figured if you also receive a pension based on work that was not covered by U.S. Social Security.
Receipt of a Swedish “basic” pension, which is based on residence in Sweden, won't affect the way your U.S. benefit is figured. For
more information, call our toll-free number, 1-800-772-1213, and get the publication, Windfall Elimination Provision (Publication
No. 05-10045). If you are outside the United States, you may write to us at the address in “For more information” section.

What you need to know about Medicare

Medicare is the U.S. national health insurance program for people age 65 or older or who are disabled.
Medicare has four parts

© Hospital insurance (Part A) helps pay for inpatient hospital care and certain follow-up services.

* Medical insurance (Part B) helps pay for doctors’ services, outpatient hospital care and other medical services.

* Medical Advantage plans (Part C) are available in many areas. People with Medicare Parts A and B can choose to receive all of
their health care services through a provider organization under Part C.

© Prescription drug coverage (Part D) helps pay for medications doctors prescribe for medical treatment.

Although the agreement between the United States and Sweden allows the Social Security Administration to count your Swedish
ATP credits to help you qualify for U.S. retirement, disability or survivors benefits, the agreement does not cover Medicare benefits.
As a result, we cannot count your credits in Sweden to establish entitlement to free Medicare hospital insurance.

For more information about Medicare, call our toll-free number, 1-800-772-1213, and get the publication, Medicare (Publication
No. 05-10043) or visit Medicare's website at www.medicare.gov.

Claims for benefits

If you live in the United States and wish to apply for U.S. or Swedish benefits:

¢ Visit or write any U.S. Social Security office; or
© Phone our toll-free number, 1-800-772-1213, 7 a.m. to 7 p.m. any business day. People who are deaf or hard of hearing may
call our toll-free TTY number, 1-800-325-0778.

You can apply for Swedish benefits at any U.S. Social Security office by completing an application form SSA-2490.
If you live in Sweden and wish to apply for U.S. or Swedish benefits, contact:

© The Federal Benefits Unit at the U.S. Embassy in Oslo, Norway (phone 47-2-2448-550) to file for U.S. benefits; or
« Any Swedish Social Security office to file for Swedish benefits.

You can apply with one country and ask to have your application considered as a claim for benefits from the other country.
Information from your application will then be sent to the other country. Each country will process the claim under its own laws—
counting credits from the other country when appropriate—and notify you of its decision.

If you have not applied for benefits before, you may need to provide certain information and documents when you apply. These
include the worker's U.S. and Swedish Social Security numbers, proof of age for all claimants, evidence of the worker's U.S. earnings
in the past 24 months and information about the worker's coverage under the Swedish system. You may wish to call the Social
Security office before you go there to see if any other information is needed.

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Social Security

Official Social Security Website

International Programs

Totalization Agreement with Sweden
SSA Publication No. 05-10189, July 2007, ICN 480194 [OMB Approval Number: 0960-0554 Expires 12/31/2016]

Contents

Introduction

Coverage and Social Security taxes

Certificate of coverage

Monthly benefits

A Swedish "ATP" pension may affect your U.S. benefit
What you need to know about Medicare

Claims for benefits

For more information

Introduction

An agreement effective January 1, 1987, between the United States and Sweden improves Social Security protection for people who
work or have worked in both countries. It helps many people who, without the agreement, would not be eligible for monthly
retirement, disability or survivors benefits under the Social Security system of one or both countries. It also helps people who would
otherwise have to pay Social Security taxes to both countries on the same earnings.

For the United States, the agreement covers Social Security taxes (including the U.S. Medicare portion) and Social Security
retirement, disability and survivors insurance benefits. It doesn’t cover benefits under the U.S. Medicare program or the
Supplemental Security Income (SSI) program.

For Sweden, the agreement applies to retirement, disability and survivors benefits under Sweden's basic and supplementary
pension programs and to the taxes that must be paid under those programs. The agreement doesn't affect benefits or tax liability
under other Swedish programs such as health insurance, unemployment insurance, work accident, occupational illness insurance or
family allowance benefits.

This document covers highlights of the agreement and explains how it may help you while you work and when you apply for
benefits.

The Agreement May Help You, Your Family And Your Employer

* While you work—If your work is covered by both the U.S. and the Swedish Social Security systems, you (and your employer,
if you are employed) would normally have to pay Social Security taxes to both countries for the same work. However, the
agreement eliminates this double coverage so you pay taxes to only one system (see the section on "Coverage and Social
Security taxes").

¢ When you apply for benefits—You may have some Social Security credits in both the United States and Sweden but not
have enough to be eligible for benefits in one country or the other. The agreement makes it easier to qualify for benefits by
letting you add together your Social Security credits in both countries. For more details, see the section on "Monthly
benefits”.

Coverage and Social Security taxes

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If you do not wish to file a claim for benefits, but would like more information about the agreement, write to:

Social Security Administration
Office of International Programs
P.O. Box 17741

Baltimore, Maryland 21235-7741
USA.

For additional information visit our website: www.socialsecurity.gov/international.

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Lump-Sum Death Benefit-A one-time | Lump-Sum Death Payment-No

payment not to exceed $255 payable on provision.

the death of an insured worker.
*Sweden has a new pension system. People born in 1938 or later receive at least part of their benefits under this new system.
People born in 1937 or earlier receive benefits only under the old system. This table shows the eligibility requirements for benefits
only under the old system.

How Benefits Can Be Paid

If you have Social Security credits in both the United States and Sweden, you may be eligible for benefits from one or both
countries. If you meet all the basic requirements under one country’s system, you will get a regular benefit from that country. If you
don't meet the basic requirements, the agreement may help you qualify for a benefit as explained below.

© Benefits from the U.S—If you do not have enough work credits under the U.S. system to qualify for regular benefits, you
may be able to qualify for a partial benefit from the United States based on both U.S. and Swedish credits. However, to be
eligible to have your Swedish credits counted, you must have earned at least six credits (generally one and one-half years of
work) under the U.S. system. If you already have enough credits under the U.S. system to qualify for a benefit, the United
States cannot count your Swedish credits.
© Benefits from Sweden—Sweden provides survivors and disability benefits two separate programs.
1. A “basic” pension program pays flat-rate benefits to Swedish residents with at least three years residence or three years
ATP coverage. The pension normally is payable outside Sweden only to Swedish nationals with at least three years of
ATP coverage. However, under the agreement, U.S. nationals residing outside Sweden can receive the basic pension on
the same basis as Swedish nationals. In addition, U.S. credits can be counted to help meet the three-year ATP coverage
requirement.

2. A “supplementary” pension program for workers, known by the initials “ATP,” pays benefits based on how long you
worked and the amount you earned. To be eligible for an ATP pension, you must generally have at least three years of
ATP credits. If you don’t meet this requirement, but have at least one year of ATP credits, U.S. credits may be counted to
help you qualify.

How Credits Get Counted

You do not have to do anything to have your credits in one country counted by the other country. If we need to count your credits
under the Swedish system to help you qualify for a U.S. benefit, we will get a copy of your Swedish record directly from Sweden
when you apply for benefits. If Swedish authorities need to count your U.S. credits to help you qualify for a Swedish benefit, they
will get a copy of your U.S. record directly from the Social Security Administration when you apply for the Swedish benefit.

Although each country may count your credits in the other country, your credits are not actually transferred from one country to
the other. They remain on your record in the country where you earned them and also can be used to qualify for benefits there.

Computation Of U.S. Benefit Under The Agreement

When a U.S. benefit becomes payable as a result of counting both U.S. and Swedish Social Security credits, an initial benefit is
determined based on your U.S. earnings as if your entire career had been completed under the U.S. system. This initial benefit is
then reduced to reflect the fact that Swedish credits helped to make the benefit payable. The amount of the reduction will depend
on the number of U.S. credits: the more U.S. credits, the smaller the reduction; and the fewer U.S. credits, the larger the reduction.

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Certificates For Employees

To establish an exemption from compulsory coverage and taxes under the Swedish system, your employer must request a
certificate of coverage (form US/SW 101) from the U.S. at this address:

Social Security Administration
Office of International Programs
P.O. Box 17741

Baltimore, Maryland 21235-7741
USA.

If preferred, the request may be sent by FAX to (410) 966-1861. Please note this FAX number should only be used for requesting
certificates of coverage.

No special form is required to request a certificate, but, the request must be in writing and provide the following information:

Full name of worker;

© Date and place of birth;

© Citizenship;

© Country of worker's permanent residence;

© US. Social Security number;

© Name and relationship of family members accompanying the worker;
e Address in Sweden, if known;

© Date of hire;

© Country of hire;

* Name and address of the employer in the U.S. and Sweden; and
© Date of transfer and anticipated date of return.

In addition, your employer must indicate if you remain an employee of the U.S. company while working in Sweden or if you become
an employee of the U.S. company’s affiliate in Sweden. If you become an employee of an affiliate, your employer must indicate if
the U.S. company has an agreement with the Internal Revenue Service under section 3121(|) of the Internal Revenue Code to pay
U.S. Social Security taxes for U.S. citizens and residents employed by the affiliate and, if yes, the effective date of the agreement.

Your employer can also request a certificate of U.S. coverage for you over the Internet using a special online request form available
at www.socialsecurity.gov/coc. Only an employer can use the online form to request a certificate of coverage. A self-employed
person must submit a request by mail or fax.

To establish your exemption from coverage under the U.S. Social Security system, your employer in Sweden must request a
certificate of coverage (form SW/US 101) from the Swedish Regional Social Insurance Office for the region in which the Swedish
employer is located.

The same information required for a certificate of coverage from the United States is needed to get a certificate from Sweden
except that you must show your Swedish Social Security number rather than your U.S. Social Security number.

Certificates For Self-Employed People

If you are self-employed and would normally have to pay Social Security taxes to both the U.S. and Swedish systems, you can
establish your exemption from one of the taxes by writing to:

If you reside in the United States, the U.S. Social Security Administration at the address in "Certificates for employees" section;
or
¢ If you reside in Sweden, the Swedish Regional Social Insurance Office for the region in which you reside.

Be sure to provide the following information in your letter:

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You are working in the U.S.:

For an employer in Sweden who:

Sweden
© Sent you to work in the U.S. for five years
or less
US.
© Sent you to work in the U.S. for more than
five years
U.S.
* Hired you in the US.
For a non-Swedish employer US.
For the Swedish government and you are a:
Sweden
© Swedish national
US.
e US. citizen
You are self-employed and you:
US.
Reside in the U.S.
Sweden

© Reside in Sweden
If this table doesn't seem to describe your situation and you are:

Write to the U.S. address in
"Certificates for employees" section
for further information.

© Working in the U.S.

a. Write to the Swedish address in "For
* Working in Sweden more information" section for

further information.

Note

As the table indicates, a U.S. worker employed in Sweden can be covered by U.S. Social Security only if he or she works for a U.S.
employer. A U.S. employer includes a corporation organized under the laws of the United States or any state, a partnership if at
least two-thirds of the partners are U.S. residents, an individual who is a resident of the U.S. or a trust if all the trustees are U.S.
residents. The term also includes a foreign affiliate of a U.S. employer if the U.S. employer has entered into an agreement with the
Internal Revenue Service under section 3121/(l) of the Internal Revenue Code to pay Social Security taxes for U.S. citizens and
residents employed by the affiliate.

Certificate of coverage

A certificate of coverage issued by one country serves as proof of exemption from Social Security taxes on the same earnings in the
other country.

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Under the U.S. Social Security program, employees and their employers, as well as self-employed people, are required to pay Social

Security taxes. Under the Swedish system, employers (but not employees) and self-employed people must pay Social Security taxes.

Before the agreement, employers and self-employed people could, under certain circumstances, be required to pay Social Security
taxes to both the United States and Sweden for the same work.

Under the agreement, if you work as an employee in the United States, you normally will be covered by the United States, and you
and your employer will pay Social Security taxes only to the United States. If you work as an employee in Sweden, you normally will
be covered by Sweden, and your employer pays Social Security taxes only to Sweden.

On the other hand, if your employer sends you from one country to work for that employer or an affiliate in the other country for
five years or less, you will continue to be covered by your home country and you will be exempt from coverage in the other
country. For example, if a U.S. company sends an employee to work for that employer or an affiliate in Sweden for no more than
five years, the employer and the employee will continue to pay only U.S. Social Security taxes and will not have to pay in Sweden.

Note

Employers of workers sent from the United States to work in Sweden for five years or less will be exempt from paying Social
Security taxes to the Swedish retirement, disability and survivors benefit programs, but they will not be exempt from paying taxes
to other Swedish benefit programs such as sickness and work injury insurance.

If you are self-employed and reside in the United States or Sweden, you generally will be covered and taxed only by the country
where you reside.

Summary Of Agreement Rules

The following table shows whether your work is covered under the U.S. or Swedish Social Security system. If you are covered under
U.S. Social Security, you and your employer (if you are an employee) must pay U.S. Social Security taxes. If you are covered under
the Swedish system, you or your employer (if you are an employee) must pay Swedish Social Security taxes. "Certificate of
coverage" section explains how to get a form from the country where you are covered that will prove you are exempt in the other
country.

Your work status Coverage and taxes
You are working in Sweden:

For a U.S. employer who:

U.S.
© Sent you to work in Sweden for five years
or less
Sweden
© Sent you to work in Sweden for more than
five years
Sweden
© Hired you in Sweden
For a non-U.S. employer Sweden

For the U.S. government and you are a:
USS. (either Social Security or federal

e US. national retirement program)

Sweden
© Swedish national

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21