Your information for the resource profile

Transcription

1 Your information for the resource profile We need information from you, so that we can process your application for a Danish early retirement pension. It is therefore important that you answer all questions as accurately as possible - your answers may decide whether you are entitled to an early retirement pension. PLEASE WRITE WITH CAPITAL LETTERS. Personal information Name: CPR.no 1 Your education 1.1 How many years did you attend school? 1.2 Have you got one or more qualifications yes no If yes: Write which one/s and which year it/they was/were completed: 1.3 Have you started one or more qualifications that you have never completed? yes no If yes: Write which one/s and when: If yes: What was the reason? 1.4 Have you undertaken further training or taken part in supplementary courses? yes no If yes: Which one/s and when: Tell us about your experience of the process:

2 2 Your health 2.1 Describe your health 2.2 Are you currently receiving treatment? yes no For which illness? By whom: General practitioner Orthopaedic surgeon Psychiatrist Physiotherapist Other specialist doctors - which one/s: Please tick if you have been hospitalised in the past year 2.3 Do you use aids such as a wheelchair, walker, cane, special equipment in the kitchen? yes no If yes: Which one/s? 2.4 How does your illness affect your everyday life - in and outside of the home? 2.5 Is there anything about your health that affects your ability to work or train?

3 3 Your working life Which positions have you held? - This applies both in Denmark and abroad. Country Period of employment (year-year) Position Job tasks Hours per week Reason for work cessation

4 4 Your work requests and possible work testing or work training 4.1 If you are not granted a Danish early retirement pension, would you consider working part- or full time, as long as your work requests and your health are taken into consideration? yes no If yes: Which job or job tasks would you consider/request? If no: What is the reason? 4.2 Have you been work tested? yes no Have you been work trained? yes no If yes: When? Which tasks would you perform were you to be work tested or work trained? Describe how you managed the more basic job tasks: What conclusions were made? If no: What was the reason for you not having been work tested or work trained?

5 5 Your accommodation and social network 5.1 Describe your housing situation: 5.2 Are you in contact with your family? yes no 5.3 Are you in contact with friends? yes no 6 Your personal skills 6.1 Describe your relationship with colleagues and others in connection with your work: 6.2 Describe your attitude towards changing work or having new job tasks or routines: 6.3 Describe what you do during the course of the day: 6.4 Describe your interests (i.e. club memberships/associations, practising of various sports, meeting up with friends, reading books, browsing the internet, interests in crafts, animals, home and garden etc.):

6 Applicant s statement, consent and signature I solemnly declare that the information in this document is correct. I am familiar with the fact that I commit a criminal offence if I supply incorrect and insufficient information in bad faith, and that I am under an obligation to pay back any amount which I may have received on the basis there of. At the same time, I give my consent to Udbetaling danmark to collect the necessary information to handle my case. Date and signature International insurance number Any international personal identification number Telephone/mobile with country code You can send the form to Udbetaling Danmark, International Pension by: - Digital Post from - mail to intpension@atp.dk - post to Kongens Vænge 8, 3400 Hillerød, Danmark.

7 How Udbetaling Danmark processes your personal data When you apply for or receive early retirement pension, you agree to Udbetaling Danmark processing some data about you. This information is called personal data. Here you can read about what data we process, how we process it and your rights in this area. What data does Udbetaling Danmark process? Udbetaling Danmark can share information with other authorities, employers, banks etc. if this is required to process your case. Udbetaling Danmark processes the personal data entered in your application and in your case. This could be information about your home, your assets, your income and your cohabitation status, which we obtain from e.g. the Population Register, relevant tax authorities or your bank. We only collect and process the data we need in order to process the case. The aim is to ensure you receive the benefit you are entitled to. How does Udbetaling Danmark process your personal data? We process your data based on the Udbetaling Danmark Act and other acts (see legal basis further down). When we process your case, we can forward information about you to other public authorities, foreign and private, who are legally bound to receive such information, or who work with us. To process your case we can obtain, share and correlate a certain amount of data without asking you: We can share data with the municipality to calculate, re-calculate, follow up or check benefit payments that you may not be entitled to. We can collect financial information from other authorities and unemployment funds if this is required to process your case, and we can get the municipality to check your salary payments. We can obtain information from other authorities, employers, banks etc. in cases concerning repayment, if such information is required to process the case. If we or the municipality have set up a case to check whether you are entitled to other services, we can share the necessary information about the case, e.g. what is being investigated and the steps taken in the case. This also applies if the case was closed in the last 6 months. To check whether you are entitled to early retirement pension, we can correlate our own information with the necessary, non-sensitive personal data from other Danish or foreign authorities and unemployment funds. The result can, in some cases, be correlated with information from PostNord or other postal companies.

8 If Udbetaling Danmark forwards information about you to an authority in a third world country, it will be done based on applicable legislation to ensure that your payments are or have been correct. Udbetaling Danmark stores your information while processing your case and deletes it 5 years after the case has been closed. The information is stored after the case has been closed due to rules in the Limitation and Archive Act etc. Udbetaling Danmark can make decisions that are based solely on automatic processing. The automatic decisions are made by e.g. Udbetaling Danmark collecting information from public registers, which together determine whether you are entitled to early retirement pension. We can also automatically process data for profiling, i.e to predict certain behaviour. What are your rights? You can withdraw your consent at any time to stop Udbetaling Danmark collecting information about you. You do this by contacting us. If you withdraw your consent it may result in you being refused, or receiving less, or no longer receiving early retirement. You can object to how Udbetaling Danmark processes the personal data about you. You can get a copy of the information that Udbetaling Danmark processes about you. You can also request: to have your personal data corrected or deleted to have the information sent to you or another for Udbetaling Danmark to put the data processing on hold. Finally, you can object to Udbetaling Danmark making automated decisions. If you have any questions about how Udbetaling Danmark processes your personal data, please contact our data protection advisor on dpo@atp.dk or on telephone If you disagree with the way Udbetaling Danmark processes your personal data, you can appeal to the Danish Data Protection Agency. Please note that the Danish Data Protection Agency is only an appeals body when it comes to processing your personal data, but not when processing your case about early retirement. If you disagree with how Udbetaling Danmark processes your case on early retirement pension, you need to contact Udbetaling Danmark. Legal basis You can read more in: The Procedural Law s 10, 11, Para. 1; 11a, para. 1-2 and 4-5, 11b 11c, Para. 1, no. 4 and 12 Udbetaling Danmark Act The Danish Act on Social Pensions (Lov om social pension). Data Protection Regulation and Data Protection Act. You can find the act on