Coordination of Social Security Systems

U2 Retention of unemployment benefit entitlement EU Regulations 883/04 and 987/09 (*) information for the holder

You may receive unemployment benefit up to the date shown in box 2 from your institution issuing this document, if you: • are moving to another EU State to look for work. • register as a jobseeker with the employment services in that State, submit to their control procedures. • register within 7 days (see box 2) of the date you ceased to be available to the employment service of the State you left. If you register after this date, your benefit will only be paid from the day you register. • continue to meet the conditions of the Member State you left. • meet the conditions of the Member State where you are seeking work.

1. personal details of the holder

1.1 Personal Identification Number  Female  Male

1.2 Surname

1.3 Forenames

1.4 Surname at birth (**)

1.5 Date of birth 1.6 Nationality

1.7 Place of birth

2. periods for which unemployment benefits may be paid by the institution issuing this document

The holder is entitled to unemployment benefit from the office issuing this document

2.1 From and either 2.2.1 to (date)

or 2.2.2 for a maximum of (days) Benefit is payable in principle if the holder registered with the employment service in the State where he/she is seeking work

2.3 at the latest by

and can continue to be paid for the above period if he/she remains registered and subject to controls by the State where he/she is seeking work throughout the period. However benefits can only continue to be paid from the date in 2.1 and for as many days as the entitlement to unemployment benefits under the law of the office issuing this document exists.

(*) Regulations (EC) No 883/2004, article 64, and 987/2009, article 55 (1). (**) Information given to the institution by the holder when this is not known by the institution.

1/2 ©European Commission

Coordination of Social Security Systems

U2 Retention of unemployment benefit entitlement

3. supplementary Information for the HOLDER

3.1 Notification of registration

The employment service in the State where you are seeking work must immediately inform the office that issued this document of the date on which you first registered in its territory and of your address there.

3.2 Monthly reporting

The employment service in the State where you are seeking work

 3.2.1 is required  3.2.2 is not required to send monthly reports to the office that issued this document

3.3 Changes of circumstances

The payment of benefits may be suspended by the State issuing this document if any of the circumstances below occur. The employment service where you are seeking work must immediately notify the issuing State if any of the following applies to you and from which date. You: • take up employment or become self-employed • receive earnings from an activity other than those mentioned above • refuse a job offer or interview request from the employment services • refuse to participate in occupational rehabilitation • are suffering from incapacity for work • do not submit to control procedures • are not available to the employment services • other

4. Institution completing THE form

4.1 Name

4.2 Street, N°

4.3 Town

4.4 Post code 4.5 Country code

4.6 Institution ID

4.7 Office fax N°

4.8 Office phone N°

4.9 E-mail

4.10 Date

4.11 Signature

stamp

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