# C_2018183EN.01000501.xml

| 29.5.2018 | EN | Official Journal of the European Union | C 183/5 |
| --- | --- | --- | --- |

29.5.2018

EN

Official Journal of the European Union

C 183/5

---

RECOMMENDATION No A1

of 18 October 2017

concerning the issuance of the attestation referred to in Article 19(2) of Regulation (EC) No 987/2009 of the European Parliament and of the Council

(Text with relevance for the EEA and for Switzerland)

(2018/C 183/06)

THE ADMINISTRATIVE COMMISSION FOR THE COORDINATION OF SOCIAL SECURITY SYSTEMS,

Having regard to Article 72(a) of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems (1), under which the Administrative Commission is responsible for dealing with all administrative questions or questions of interpretation arising from the provisions of this Regulation and Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems (2),

Having regard to Article 5 of Regulation (EC) No 987/2009 concerning the legal value of documents and supporting evidence showing the position of a person,

Having regard to Article 19(2) of Regulation (EC) No 987/2009 concerning the attestation of the applicable legislation pursuant to Title II of Regulation (EC) No 883/2004,

Acting in accordance with the conditions laid down in Article 71(2) of Regulation (EC) No 883/2004,

Whereas:

| (1) | Article 19(2) of Regulation (EC) No 987/2009 provides that at the request of the person concerned or of the employer, the competent institution of the Member State whose legislation is applicable pursuant to Title II of Regulation (EC) No 883/2004 shall provide an attestation that such legislation is applicable and shall indicate, where appropriate, until what date and under what conditions. |
| --- | --- |

(1)

Article 19(2) of Regulation (EC) No 987/2009 provides that at the request of the person concerned or of the employer, the competent institution of the Member State whose legislation is applicable pursuant to Title II of Regulation (EC) No 883/2004 shall provide an attestation that such legislation is applicable and shall indicate, where appropriate, until what date and under what conditions.

| (2) | The Administrative Commission determines the structure and the content of the Portable Document A1 concerning the applicable legislation which applies to the holder. |
| --- | --- |

(2)

The Administrative Commission determines the structure and the content of the Portable Document A1 concerning the applicable legislation which applies to the holder.

| (3) | Article 5(1) of Regulation (EC) No 987/2009 provides that this document shall be accepted by the institutions of the other Member State as long as it has not been withdrawn or declared invalid by the Member State in which it has been issued. |
| --- | --- |

(3)

Article 5(1) of Regulation (EC) No 987/2009 provides that this document shall be accepted by the institutions of the other Member State as long as it has not been withdrawn or declared invalid by the Member State in which it has been issued.

| (4) | The principle of sincere cooperation, as also laid down in Article 4(3) of the Treaty on European Union and specified in Article 76 of Regulation (EC) No 883/2004, requires that institutions conduct a proper assessment of the facts relevant for the determination of the legislation applicable in the matter of social security and consequently to confirm the correctness of the information contained in a Portable Document A1. |
| --- | --- |

(4)

The principle of sincere cooperation, as also laid down in Article 4(3) of the Treaty on European Union and specified in Article 76 of Regulation (EC) No 883/2004, requires that institutions conduct a proper assessment of the facts relevant for the determination of the legislation applicable in the matter of social security and consequently to confirm the correctness of the information contained in a Portable Document A1.

| (5) | These documents establish a presumption that the holder is properly affiliated to the social security system of the Member State whose institution has issued it, |
| --- | --- |

(5)

These documents establish a presumption that the holder is properly affiliated to the social security system of the Member State whose institution has issued it,

HEREBY RECOMMENDS TO THE COMPETENT SERVICES AND INSTITUTIONS THAT:

| 1. | In order to prevent falsification of the Portable Document A1, for example by exchanging pages between different documents, it is recommended that authentication features should be included in the certificates issued, namely:






  (a) | where the documents are issued electronically, they should bear a serial number or identification number on each page. In this case, a manual signature or ink stamping is no longer necessary; |
| --- | --- | --- |

1.

(a)

where the documents are issued electronically, they should bear a serial number or identification number on each page. In this case, a manual signature or ink stamping is no longer necessary;

| (b) | where the documents are issued manually, they should be printed on both pages of a sheet and the sheets should be connected together in such a way that they cannot easily be separated. This can be achieved, for example, by folding the top left hand corner, stapling this corner and putting a stamp on the reverse side. |
| --- | --- |

(b)

where the documents are issued manually, they should be printed on both pages of a sheet and the sheets should be connected together in such a way that they cannot easily be separated. This can be achieved, for example, by folding the top left hand corner, stapling this corner and putting a stamp on the reverse side.

| 2. | In addition, it is recommended that each issued Portable Document A1 is registered in such a way that its authenticity can easily and quickly be verified. |
| --- | --- |

2.

| 3. | The Member States should inform the Administrative Commission about the different ways the Portable Documents A1 are issued by their institutions. The delegations in the Administrative Commission should share this information with their respective inspectorates. |
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3.

| 4. | It is recommended that, prior to issuing a Portable Document A1, institutions assess all the relevant facts, whether by means of data contained in official sources, or by requesting the applicant to provide the necessary information. To guide institutions, a non-exhaustive standardised list of common questions and questions specific to the different relevant articles of Regulation (EC) No 883/2004 can be found in the Annex. These may be adapted as appears appropriate in the case involved. |
| --- | --- |

4.

| 5. | A disclaimer should be included in the application forms by which the applicant declares that he/she has answered all questions correctly to the best of his/her knowledge and that he/she is aware of the possibility of checks with the consequence that the document can be withdrawn retroactively. |
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5.

| 6. | It is recommended that the competent institutions have the information about Portable Documents A1 issued available, preferably in an electronic database. They should notify each other, by means of the Electronic Exchange of Social Security Information (EESSI) System, of any decision taken regarding the applicable legislation in the event of an activity pursued in the other Member State pursuant to Article 15(1) of Regulation (EC) No 987/2009. |
| --- | --- |

6.

| 7. | This Recommendation shall be published in the Official Journal of the European Union. It enters into force on the twentieth day following that of its publication. |
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7.

The Chair of the Administrative Commission

Agne NETTAN-SEPP

---

(1)  OJ L 166, 30.4.2004, p. 1.

1

(2)  OJ L 284, 30.10.2009, p. 1.

2

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ANNEX

Standardised sets of questions for the application for a Portable Document A1

A.   COMMON QUESTIONS REGARDING THE PERSON CONCERNED OF THE PORTABLE DOCUMENT A1 (PD A1)

The following questions need to be used in every application form and to be verified by the issuing institution:

| — | Surname/Last name |
| --- | --- |

—

Surname/Last name

| — | First name |
| --- | --- |

—

First name

| — | Date of birth |
| --- | --- |

—

Date of birth

| — | Sex: male/female/unknown |
| --- | --- |

—

Sex: male/female/unknown

| — | Personal identification number |
| --- | --- |

—

Personal identification number

| — | Place of birth |
| --- | --- |

—

Place of birth

| — | Nationality |
| --- | --- |

—

Nationality

| — | The person resides legally in a Member State (for third-country nationals) |
| --- | --- |

—

The person resides legally in a Member State (for third-country nationals)

| — | Address in the State of residence (at least town, postal code, country) |
| --- | --- |

—

Address in the State of residence (at least town, postal code, country)

| — | Address in the State of stay (at least town, postal code, country) |
| --- | --- |

—

Address in the State of stay (at least town, postal code, country)

| — | Contact address of the person |
| --- | --- |

—

Contact address of the person

| — | Job-title/Profession/Trade |
| --- | --- |

—

Job-title/Profession/Trade

B.   SPECIFIC QUESTIONS DEPENDING ON THE DIFFERENT CIRCUMSTANCES IN WHICH THE PD A1 IS REQUESTED

In addition, specific questions depending on the various circumstances in which a PD A1 may be requested based on Tittle II of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems (1) are set out below.

1.   Application under Article 11(3)(a) of Regulation (EC) No 883/2004 (activity as an employed or self-employed person in one Member State)

| — | Employer






  — | Name |
| --- | --- | --- |

—

Employer

—

Name

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Self-employment activity






  — | Name |
| --- | --- | --- |

—

Self-employment activity

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Starting/ending date of work |
| --- | --- |

—

Starting/ending date of work

2.   Application under Article 11(3)(b) of Regulation (EC) No 883/2004 (civil servants)

| — | Employer (employing administration)






  — | Name |
| --- | --- | --- |

—

Employer (employing administration)

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Place(s) of work abroad (repeat as many times as needed)






  — | Name |
| --- | --- | --- |

—

Place(s) of work abroad (repeat as many times as needed)

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | Starting date of work abroad |
| --- | --- |

—

Starting date of work abroad

| — | Ending date of work abroad |
| --- | --- |

—

Ending date of work abroad

3.   Application under Article 11(4) of Regulation (EC) No 883/2004 (economic activity on board a vessel at sea)

| — | Employer






  — | Name |
| --- | --- | --- |

—

Employer

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | Name of the vessel |
| --- | --- |

—

Name of the vessel

| — | The State of which the vessel is flying the flag |
| --- | --- |

—

The State of which the vessel is flying the flag

| — | The remuneration is paid by the undertaking whose registered office or place of business is in another State: yes/no |
| --- | --- |

—

The remuneration is paid by the undertaking whose registered office or place of business is in another State: yes/no

| — | Starting date of work |
| --- | --- |

—

Starting date of work

| — | Ending date of work |
| --- | --- |

—

Ending date of work

4.   Application under Article 11(5) of Regulation (EC) No 883/2004 (flight crew or cabin crew members)

| — | Employer






  — | Name |
| --- | --- | --- |

—

Employer

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Place where the home base is situated |
| --- | --- |

—

Place where the home base is situated

| — | Starting date of work |
| --- | --- |

—

Starting date of work

| — | Ending date of work |
| --- | --- |

—

Ending date of work

5.   Application under Article 12(1) of Regulation (EC) No 883/2004 (posting of workers)

| — | Employer in the posting State






  — | Name |
| --- | --- | --- |

—

Employer in the posting State

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Statistical Classification of Economic Activities in the European Community according to NACE |
| --- | --- |

—

Statistical Classification of Economic Activities in the European Community according to NACE

| — | Undertaking(s) in the receiving State/place(s) of posting






  — | Name |
| --- | --- | --- |

—

Undertaking(s) in the receiving State/place(s) of posting

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | Starting date of posting |
| --- | --- |

—

Starting date of posting

| — | Ending date of posting |
| --- | --- |

—

Ending date of posting

| — | The employee is subject to legislation of the posting State within one month before posting: yes/no |
| --- | --- |

—

The employee is subject to legislation of the posting State within one month before posting: yes/no

| — | Details of activity performed one month immediately prior to posting |
| --- | --- |

—

Details of activity performed one month immediately prior to posting

| — | Nature of activity in posting State |
| --- | --- |

—

Nature of activity in posting State

| — | Nature of activity in receiving State |
| --- | --- |

—

Nature of activity in receiving State

| — | The employee is being posted to replace another posted worker: yes/no |
| --- | --- |

—

The employee is being posted to replace another posted worker: yes/no

| — | If yes, please indicate, why this replacement is deemed necessary |
| --- | --- |

—

If yes, please indicate, why this replacement is deemed necessary

| — | The employee has already worked in the receiving Member State concerned: yes/no |
| --- | --- |

—

The employee has already worked in the receiving Member State concerned: yes/no

| — | If yes, indicate the previous periods of posting (date from, date to) |
| --- | --- |

—

If yes, indicate the previous periods of posting (date from, date to)

| — | Number of employees of the employer in the posting State (excluding administrative workers) |
| --- | --- |

—

Number of employees of the employer in the posting State (excluding administrative workers)

| — | number of administrative workers in the posting State |
| --- | --- |

—

number of administrative workers in the posting State

| — | Number of posted employees |
| --- | --- |

—

Number of posted employees

| — | Number of contracts exercised in the posting State |
| --- | --- |

—

Number of contracts exercised in the posting State

| — | Number of contracts exercised in the receiving State |
| --- | --- |

—

Number of contracts exercised in the receiving State

| — | Turnover in the posting State (in %) |
| --- | --- |

—

Turnover in the posting State (in %)

| — | Turnover in the receiving Member State (in %) |
| --- | --- |

—

Turnover in the receiving Member State (in %)

| — | The employer in posting State may decide to terminate the contract with the employees during their posting: yes/no |
| --- | --- |

—

The employer in posting State may decide to terminate the contract with the employees during their posting: yes/no

| — | The employer in posting State is able to decide the key aspects of the activity performed in the receiving State: yes/no |
| --- | --- |

—

The employer in posting State is able to decide the key aspects of the activity performed in the receiving State: yes/no

| — | The employment contract is concluded with: the employer in the posting State/the undertaking in the receiving State |
| --- | --- |

—

The employment contract is concluded with: the employer in the posting State/the undertaking in the receiving State

| — | The employee will be paid by: the employer in the posting State/the undertaking in the receiving State |
| --- | --- |

—

The employee will be paid by: the employer in the posting State/the undertaking in the receiving State

| — | Will the employment relationship continue during the period of posting: yes/no |
| --- | --- |

—

Will the employment relationship continue during the period of posting: yes/no

| — | Will the undertaking to which the employee is posted place him at the disposal of another undertaking: yes/no |
| --- | --- |

—

Will the undertaking to which the employee is posted place him at the disposal of another undertaking: yes/no

6.   Application under Article 12(2) of Regulation (EC) No 883/2004 (posting of self-employed persons)

| — | Self-employment in the posting State






  — | Name |
| --- | --- | --- |

—

Self-employment in the posting State

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Self-employment in the receiving State/Place of posting






  — | Name |
| --- | --- | --- |

—

Self-employment in the receiving State/Place of posting

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | Starting date of posting |
| --- | --- |

—

Starting date of posting

| — | Ending date of posting |
| --- | --- |

—

Ending date of posting

| — | The self-employed has already worked in the receiving Member State: yes/no |
| --- | --- |

—

The self-employed has already worked in the receiving Member State: yes/no

| — | If yes, indicate the previous periods of posting (date from, date to) |
| --- | --- |

—

If yes, indicate the previous periods of posting (date from, date to)

| — | During the posting, a business structure will be maintained in the posting State, so that business activity can be resumed on return from abroad: yes/no |
| --- | --- |

—

During the posting, a business structure will be maintained in the posting State, so that business activity can be resumed on return from abroad: yes/no

| — | Business activity will be resumed on return from the receiving Member State |
| --- | --- |

—

Business activity will be resumed on return from the receiving Member State

| — | Nature of activity in posting State
  Nature of activity in receiving State |
| --- | --- |

—

Nature of activity in posting State

Nature of activity in receiving State

7.   Application under Article 13(1) of Regulation (EC) No 883/2004 (employment in two or more Member States when employer(s) is/are situated in the State of residence of the person)

| — | Employer






  — | Name |
| --- | --- | --- |

—

Employer

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | States where work is performed |
| --- | --- |

—

States where work is performed

| — | Details regarding place(s) of work (repeat as many times as needed)






  — | Company name |
| --- | --- | --- |

—

Details regarding place(s) of work (repeat as many times as needed)

—

Company name

| — | ID number(s) |
| --- | --- |

—

ID number(s)

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | States where activities accounting for less than 5 % of the worker’s regular working time and/or less than 5 % of overall remuneration |
| --- | --- |

—

States where activities accounting for less than 5 % of the worker’s regular working time and/or less than 5 % of overall remuneration

| — | Starting date of work in each undertaking |
| --- | --- |

—

Starting date of work in each undertaking

| — | Ending date of work in each undertaking |
| --- | --- |

—

Ending date of work in each undertaking

8.   Application under Art. 13(1) of Regulation (EC) No 883/2004 (employment in two or more Member States — other situations)

| — | Employer(s) (repeat as many times as needed)






  — | Name |
| --- | --- | --- |

—

Employer(s) (repeat as many times as needed)

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Statistical Classification of Economic Activities in the European Community of the employer according to NACE |
| --- | --- |

—

Statistical Classification of Economic Activities in the European Community of the employer according to NACE

| — | States where work is performed |
| --- | --- |

—

States where work is performed

| — | Details regarding place(s) of work (repeat as many times as needed)






  — | Company name |
| --- | --- | --- |

—

Details regarding place(s) of work (repeat as many times as needed)

—

Company name

| — | ID number(s) |
| --- | --- |

—

ID number(s)

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | States where activities accounting for less than 5 % of the worker’s regular working time and/or less than 5 % of overall remuneration |
| --- | --- |

—

States where activities accounting for less than 5 % of the worker’s regular working time and/or less than 5 % of overall remuneration

| — | States where activities accounting for at least 25 % of the worker’s regular working time and/or at least 25 % of overall remuneration |
| --- | --- |

—

States where activities accounting for at least 25 % of the worker’s regular working time and/or at least 25 % of overall remuneration

| — | Starting date of work in each undertaking |
| --- | --- |

—

Starting date of work in each undertaking

| — | Ending date of work in each undertaking |
| --- | --- |

—

Ending date of work in each undertaking

9.   Application under Article 13(2) of Regulation (EC) No 883/2004 (self-employment in two or more Member States)

| — | Self-employment activity






  — | Name |
| --- | --- | --- |

—

Self-employment activity

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Statistical Classification of Economic Activities in the European Community of the self-employment according to NACE |
| --- | --- |

—

Statistical Classification of Economic Activities in the European Community of the self-employment according to NACE

| — | States where work is performed |
| --- | --- |

—

States where work is performed

| — | Details regarding place(s) of self-employment activity (repeat as many times as needed)






  — | Company name (if applicable) |
| --- | --- | --- |

—

Details regarding place(s) of self-employment activity (repeat as many times as needed)

—

Company name (if applicable)

| — | ID number(s) (if applicable) |
| --- | --- |

—

ID number(s) (if applicable)

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | Turnover and/or income in each State where activity is performed |
| --- | --- |

—

Turnover and/or income in each State where activity is performed

| — | Working time in each State where activity is performed |
| --- | --- |

—

Working time in each State where activity is performed

| — | Number of services rendered in each State where activity is performed |
| --- | --- |

—

Number of services rendered in each State where activity is performed

| — | Starting date of activity |
| --- | --- |

—

Starting date of activity

| — | Ending date of activity |
| --- | --- |

—

Ending date of activity

10.   Application under Art. 13(3) of Regulation (EC) No 883/2004 (employment and self-employment in two or more Member States)

| — | Self-employment activity (repeat as many times as needed)






  — | Name |
| --- | --- | --- |

—

Self-employment activity (repeat as many times as needed)

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Employer (repeat as many times as needed)






  — | Name |
| --- | --- | --- |

—

Employer (repeat as many times as needed)

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Statistical Classification of Economic Activities in the European Community of the employer according to NACE |
| --- | --- |

—

Statistical Classification of Economic Activities in the European Community of the employer according to NACE

| — | States where work is performed |
| --- | --- |

—

States where work is performed

| — | Details regarding places of activity (repeat as many times as needed)






  — | Address (at least town, postal code, country) |
| --- | --- | --- |

—

Details regarding places of activity (repeat as many times as needed)

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | States where activities accounting for less than 5 % of the worker’s regular working time and/or less than 5 % of overall remuneration |
| --- | --- |

—

States where activities accounting for less than 5 % of the worker’s regular working time and/or less than 5 % of overall remuneration

| — | States where activities accounting for at least 25 % of the worker’s regular working time and/or at least 25 % of overall remuneration |
| --- | --- |

—

States where activities accounting for at least 25 % of the worker’s regular working time and/or at least 25 % of overall remuneration

| — | Starting date of activity |
| --- | --- |

—

Starting date of activity

| — | Ending date of activity |
| --- | --- |

—

Ending date of activity

11.   Application under Art. 13(4) of Regulation (EC) No 883/2004 (civil servant in one State and employed or self-employed person in another)

| — | Employer (employing administration)






  — | Name |
| --- | --- | --- |

—

Employer (employing administration)

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Self-employment activity and/or employment activity (repeat as many times as needed)






  — | Name |
| --- | --- | --- |

—

Self-employment activity and/or employment activity (repeat as many times as needed)

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Starting date of work |
| --- | --- |

—

Starting date of work

| — | Ending date of work |
| --- | --- |

—

Ending date of work

12.   Application under Article 15 of Regulation (EC) No 883/2004 (contract staff of the European Union)

| — | Employer (employing EU institution or body)






  — | Name |
| --- | --- | --- |

—

Employer (employing EU institution or body)

—

Name

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | Place of work abroad






  — | Name |
| --- | --- | --- |

—

Place of work abroad

—

Name

| — | Registration number |
| --- | --- |

—

Registration number

| — | Social security number |
| --- | --- |

—

Social security number

| — | Fiscal number |
| --- | --- |

—

Fiscal number

| — | Address (at least town, postal code, country) |
| --- | --- |

—

Address (at least town, postal code, country)

| — | No fixed address in the state of work |
| --- | --- |

—

No fixed address in the state of work

| — | Starting date of work as contract Staff of the European Union |
| --- | --- |

—

Starting date of work as contract Staff of the European Union

| — | The legislation for which the person concerned opted: the legislation of the State in which he/she is employed/the legislation of the State to which he/she was last subject/the legislation of the State of his/her nationality |
| --- | --- |

—

The legislation for which the person concerned opted: the legislation of the State in which he/she is employed/the legislation of the State to which he/she was last subject/the legislation of the State of his/her nationality

C.   SAMPLE DISCLAIMERS TO BE USED IN APPLICATION FORMS

1.   General:

| — | ‘I declare that the information on this form is true and complete.’ |
| --- | --- |

—

‘I declare that the information on this form is true and complete.’

| — | ‘I have answered all the questions correctly to the best of my knowledge.’ |
| --- | --- |

—

‘I have answered all the questions correctly to the best of my knowledge.’

2.   Posting of employed persons:

| — | ‘I declare that I am aware of the possibility of checks throughout the period of posting so as to ascertain that this period has not come to an end. Such checks may relate, in particular, to the payment of contributions and to the maintenance of the direct relationship.’ |
| --- | --- |

—

‘I declare that I am aware of the possibility of checks throughout the period of posting so as to ascertain that this period has not come to an end. Such checks may relate, in particular, to the payment of contributions and to the maintenance of the direct relationship.’

| — | ‘As employer of the posted employee, I declare that the information is complete and correct. I am aware of the fact, that the provided information may be scrutinised in <name of the posting Member State> as well as in the receiving State by the competent institution. If the provided information is not in accordance with the factual situation, the document regarding the applicable legislation can be withdrawn retroactively. In this case, the legislation of the receiving State where the employment is actually performed will be applicable. I commit myself to inform the competent institution in <name of the posting Member State> (i) if the employee has not been posted or if the posting period is interrupted for more than two months or (ii) if the posting is terminated before the end of the presumed posting period.’ |
| --- | --- |

—

‘As employer of the posted employee, I declare that the information is complete and correct. I am aware of the fact, that the provided information may be scrutinised in <name of the posting Member State> as well as in the receiving State by the competent institution. If the provided information is not in accordance with the factual situation, the document regarding the applicable legislation can be withdrawn retroactively. In this case, the legislation of the receiving State where the employment is actually performed will be applicable. I commit myself to inform the competent institution in <name of the posting Member State> (i) if the employee has not been posted or if the posting period is interrupted for more than two months or (ii) if the posting is terminated before the end of the presumed posting period.’

3.   Posting of self-employed persons:

| — | ‘I declare that I am aware of the possibility of checks throughout the period during which I pursue a temporary activity in the State in which I am active, so as to ascertain that the conditions applying to that activity have not changed. Such checks may relate, in particular, to the payment of contributions and the maintenance of the infrastructure needed to pursue the activity in the State in which I am established.’ |
| --- | --- |

—

‘I declare that I am aware of the possibility of checks throughout the period during which I pursue a temporary activity in the State in which I am active, so as to ascertain that the conditions applying to that activity have not changed. Such checks may relate, in particular, to the payment of contributions and the maintenance of the infrastructure needed to pursue the activity in the State in which I am established.’

4.   Activities for one employer in two or more Member States — disclaimer for the employer:

| — | ‘I declare that the information is complete and correct. I am aware of the fact that the provided information may be scrutinised in <name of the posting Member State> as well as in the receiving State of employment by the competent institution. If the provided information is not in accordance with the factual situation, the document regarding the applicable legislation can be withdrawn retroactively. In this case, the question which legislation is applicable will have to be determined again on the basis of the factual circumstances. I commit myself to inform the competent institution of <name of the posting Member State> about all changes regarding the employment relationship (i.e. change of employer, change of the centre of interests, change of working hours, taking up new activities).’ |
| --- | --- |

—

‘I declare that the information is complete and correct. I am aware of the fact that the provided information may be scrutinised in <name of the posting Member State> as well as in the receiving State of employment by the competent institution. If the provided information is not in accordance with the factual situation, the document regarding the applicable legislation can be withdrawn retroactively. In this case, the question which legislation is applicable will have to be determined again on the basis of the factual circumstances. I commit myself to inform the competent institution of <name of the posting Member State> about all changes regarding the employment relationship (i.e. change of employer, change of the centre of interests, change of working hours, taking up new activities).’

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(1)  OJ L 166, 30.4.2004, p. 1.

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