AHV/EL Mitteilung Nr. 279 vom 26.01.2011

1.1 Full Name:

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1.2 Date of Birth:

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1.3 Nationality:

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1.4 Social Security Number:

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1.5 Permanent Residence:

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2. Employer: in India in Switzerland

2.1 Name:

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2.2 Address:

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3. Place of work: in Switzerland in India

3.1 Name of employer:

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3.2 Address:

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4. Certification: 4.1 The insured person remains subject to the Indian/Swiss legislation in accordance with the following article of the Social Security Agreement:

6 7 8

4.2 from: to:

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5. Agency delivering the present certificate:

Name: Address: Date _____________________________ ............................... (Signature)

Stamp