Unemployment_Benefits | Lexipedia

UB_BUC_01-BPMN

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UB_BUC_03-BPMN Diagram

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Coordination of Social Security Systems

U1 Periods to be taken into account for granting unemployment benefits EU Regulations 883/04 and 987/09 (*) INFORMATION FOR THE HOLDER

This document is for an unemployed person who claims unemployment benefits in a Member State and who was previously insured or worked in another Member State. Where appropriate, it is issued by the latter Member State. You should submit it to the employment service or the insurance fund in the country where you claim. The Member State where the claim is made will take into account, to the extent necessary, the periods shown in this certificate.

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

1.8 Current address in the State issuing the certificate

1.8.1 Street, N° 1.8.3 Post code 1.8.2 Town 1.8.4 Country code

2. THE HOLDER HAS COMPLETED THE FOLLOWING PERIODS1:

2.1 PERIODS OF INSURANCE AND PERIODS TREATED AS SUCH 2.1.1 Insured employment From to From to From to From to From to From to From to 2.1.2 Insured self employment From to From to From to From to From to From to From to

(*) Regulations (EC) No 883/2004, articles 61 and 62, and 987/2009 article 54 (1 and 2). (**) Information given to the institution by the holder when this is not known by the institution.

©European Commission Coordination of Social Security Systems

U1 Periods to be taken into account for granting unemployment benefits

2. THE HOLDER HAS COMPLETED THE FOLLOWING PERIODS (CONTINUED):

2.1 PERIODS OF INSURANCE AND PERIODS TREATED AS SUCH (CONTINUED)

2.1.3 Other periods of insurance

From to Type 2 From to Type 2 From to Type 2

2.1.4 Periods treated as periods of insurance

From to Reason 3 From to Reason 3 From to Reason 3

2.2 PERIODS OF EMPLOYMENT AND SELF EMPLOYMENT, WHICH ARE NOT INSURANCE PERIODS

2.2.1 Employment

From to Activity From to Activity From to Activity

2.2.2 Self employment

From to Activity From to Activity From to Activity

2.2.3 These are not insurance periods because

2.3 INCOME DETAILS 4,5

2.3.1 Income from employment

From to Wage From to Wage From to Wage

2.3.2 Income from self-employment

From to Earnings From to Earnings From to Earnings

3. REASON FOR END OF EMPLOYMENT

 3.1 termination by employer  3.4 resignation by the employee  3.2 contract terminated by mutual consent  3.5 contract expired  3.3 dismissal for disciplinary reasons  3.6 redundancy  3.7 other (employment)

 3.8 other (self-employment)

Coordination of Social Security Systems

U1 Periods to be taken into account for granting unemployment benefits

4. OTHER RECEIVED PAYMENTS

The holder

 4.1 has received or has still to receive wages for the period after end of employment, up to  4.2 has received or has still to receive compensation for ending of employment or other similar payment, amounting to

 4.3 has received or has still to receive payment in lieu of annual leave, amounting to for days

 4.4 has waived the above rights under their employment contract

4.4.1 Reason

 4.5 is currently receiving other benefits

5. SINCE THE BEGINNING OF THE FIRST PERIOD COVERED IN BOX 2 THE HOLDER HAS RECEIVED UNEMPLOYMENT BENEFIT

5.1 Period

From to From to From to

5.2 Last local employment or benefit agency

5.3 Identification N°

5.4 Name

5.5 Address

5.5.1 Street, N° 5.5.3 Post code 5.5.2 Town 5.5.4 Country code

6. UNEMPLOYMENT BENEFIT ENTITLEMENT

6.1  The holder is entitled to unemployment benefits from the office issuing this document Under Article  64  65 (5) (b) of Regulation 883/2004 For the period From to

6.2  The holder is not entitled to unemployment benefits from the office issuing this document because  No entitlement exists under the State’s laws  The holder did not apply to have their unemployment benefits exported

Coordination of Social Security Systems

U1 Periods to be taken into account for granting unemployment benefits

7. INSTITUTION COMPLETING THE FORM

7.1 Name

7.2 Street, N°

7.3 Town

7.4 Post code 7.5 Country code

7.6 Institution ID

7.7 Office fax N°

7.8 Office phone N°

7.9 E-mail

7.10 Date

7.11 Signature

STAMP

NOTES

[1] The period(s) recorded in box 2 of this document are provided in accordance with the reference periods shown in this Note for the Member State concerned. The reference periods are: One year - if the document is to be presented to Luxembourg institution. Two Years - if it is to be presented to an Italian, Icelandic, Liechtenstein or Swiss institution. Italy may also request information on the complete insurance history abroad of the named person. For the purposes of Swiss institutions, four years in the case of child education or self-employment of short duration. Three years - if it is to be presented to a Belgian, Cypriot, Czech, Danish, French, Greek, Irish, Portuguese or United Kingdom institution. More than three years - if the document is to be presented to a Finnish (20 years), Spanish (6 years), German (5 years), Austrian (10, 15 or 25 years), Hungarian and Slovak (4 years), Swedish (8 years), Polish (20 years), Bulgarian, Estonian, Latvian, Netherlands (years since 1998), Romanian, Slovenian or Maltese institution (total insurance history). In some cases the Belgian institution requests information on the complete insurance periods. If necessary, as regards workers aged 52 or over, the Spanish institution may require information on supplementary periods preceding the last six years. The last ended calendar year or the three last calendar years - if the form is to be presented to a Norwegian institution. [2] Please complete as appropriate: Maternity or child-rearing; Sickness; Deprivation of liberty; Education; Military or alternative civil service; Unemployment benefits before commencing last employment; Other (please indicate) [3] Indicate whether the periods treated as such refer to, for example, i Periods of sickness – indicate the name and address of the health insurance fund/company ii Periods of maternity or child-rearing – indicate the name and address of the health insurance fund/company iii Period of deprivation of liberty iv Period of education v Period of Military or alternative civilian service vi Period of granting unemployment benefits before commencement of the last employment [4] If the income details are not immediately available at the time of the request, the institution completing this document shall leave this part blank and submit the income details later, if required. Income time reference periods, counted from the end of last employment/insurance, backwards. Austria, Spain: last six month; Czech Republic: last employment; Estonia, France, Hungary, the Netherlands, Romania: last 12 months; Bulgaria: last 15 months; Germany, Slovakia: last 24 months; Poland: incomes from employment and self-employment that are not insurance periods; Cyprus, Malta, UK: no need to fill. [5] Type of income. Austria, Belgium, Bulgaria, Hungary, the Netherlands, Poland: gross income; Estonia, France, Romania, Slovakia: gross income for each month (or monthly average); Germany: gross income for each month (or monthly average) and the average weekly hours; Czech Republic (monthly net average): net income. Cyprus, Malta, UK: no need to fill.

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.

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

Coordination of Social Security Systems

U3 Circumstances likely to affect the entitlement to unemployment benefits EU Regulations 883/04 and 987/09 (*) INFORMATION FOR THE HOLDER

This document contains information about your circumstances which have been passed by the institution in the State where you seek a job to the institution paying your unemployment benefit. It may result in your unemployment benefit being stopped. If you disagree with this information please contact the institution paying your benefit without delay.

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

1.8 Current address in the State issuing the certificate

1.8.1 Street, N° 1.8.3 Post code 1.8.2 Town 1.8.4 Country code

1.9 Address in the State paying unemployment benefits

1.9.1 Street, N° 1.9.3 Post code 1.9.2 Town 1.9.4 Country code

2. APPLICABLE CIRCUMSTANCES STARTING DATE

The holder

2.1 has taken up employment or has become self-employed  2.2 is receiving earnings from an activity other than those  mentioned above (2.1) 2.3 has refused a job offer or interview request from the  employment services 2.4 has refused to participate in occupational rehabilitation  2.5 is suffering from incapacity for work  2.6 did not submit to control procedures  2.7 is not available to the employment services  2.8 other: 

(*) Regulations (EC) No 883/2004, article 64, and 987/2009, article 55 (4). (**) Information given to the institution by the holder when this is not known by the institution.