Modified by decision n and OJ Reference /03/2005 L77 15/03/2006
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1 GENERAL E001 Request for information, communication of information, request for forms, /10/93 reminder on an employed person, self-employed person, a frontier worker, a pensioner, an unemployed person, a dependant.
2 POSTING E101 Certificate concerning the legislation applicable /11/96 L216 08/08/ /12/98 L143 8/6/99 corrigendum: L159 25/6/99 p /06/02 L55 1/03/2003 E101a Certificate concerning the legislation applicable to unemployed Recommendation n 18 28/02/86 persons engaged in part-time work in a MS other than the State of C284 11/11/86 residence E102 Extension of term of posting or of activity as a self-employed person /11/96 L216 08/08/97
3 HEALTHCARE SECTOR E103 Exercising the right of option /10/93 E104 E105 Certificate concerning the aggregation of periods of /10/93 insurance, employment or residence Certificate concerning the members of the family of an /10/93 employed person or self-employed person to be taken into consideration for the calculation of cash benefits in the case of incapacity for work E106 Certificate of entitlement to sickness and maternity /10/93 insurance benefits in kind for persons residing in a country other than the competent country /10/97 L195 11/07/98 Withdrawn E107 E108 Application for a certificate of entitlement to benefits in /10/93 kind Notification of suspension or withdrawal of the right to /10/93 sickness and maternity insurance benefits in kind /06/02 L55 1/03/2003 E109 Certificate for the registration of members of the /10/93 employed or self-employed person's family and the updating of lists /10/97 L195 11/07/98 E110 Certificate concerning employed persons in international transport /10/ /03/04 L259 05/08/04
4 E111 Certificate of entitlement to benefits in kind during a stay in a Member State /10/ /06/02 L93 10/04/ /03/04 L259 05/08/ /06/03 L276 7/10/03 E111B For hospitalisation only - Certificate of entitlement to /10/93 benefits in kind during a stay in a Member State - Scheme for self-employed persons /06/02 L93 10/04/ /06/03 L276 7/10/03 E112 Certificate concerning the retention of the right to /10/93 sickness or maternity benefits currently being provided E113 Hospitalisation: notification of entering and leaving hospital /10/ /03/04 L259 05/08/04 E114 Granting of major benefits in kind /10/ /03/04 L259 05/08/04 E115 Claim for cash benefits for incapacity for work /10/93 E116 E117 E118 Medical report relating to incapacity for work (sickness, maternity, accident at work, occupational disease) /10/93 Granting of cash benefits in the case of maternity and /10/93 incapacity for work Notification of non-recognition or of end of incapacity for /10/93 work
5 E118 Annex Legal remedies and periods allowed for appeals /10/93 E119 E120 E121 Certificate concerning the entitlement of unemployed /10/93 persons and the members of their family to sickness and maternity insurance benefits Certificate of entitlement to benefits in kind for pension /10/93 claimants and members of their family Certificate for the registration of pensioners and the /10/93 updating of lists /03/04 L259 5/08/ /06/98 L195 11/07/98 E122 Certificate for the granting of benefits in kind to members of the family of pensioners /10/93 E123 Certificate of entitlement to benefits in kind under /10/93 insurance against accidents at work and occupational diseases E124 Claim for death grant /10/93 E124 additional Additional information for the purposes of Portuguese /10/93 E125 Individual record of actual expenditure /10/93 E125A additional Additional information for the purposes of Norwegian /10/ /06/98 L195 11/07/ /10/93 E126 Rates for refund of benefits in kind /10/93
6 E127 Individual record of monthly lump-sum payments /10/ /06/98 L195 11/07/98 E128 Certificate of entitlement to necessary benefits in kind during a stay in a Member State /06/97 L341 12/12/ /06/98 L195 11/07/ /10/99 L302 1/12/ /03/04 L259 05/08/04 E128B Certificate of entitlement to necessary benefits in kind /06/97 during a stay in a Member State : for hospitalisation only L341 12/12/97 - scheme for self-employed persons 177 5/10/99 L302 1/12/ /03/04 L259 05/08/04
7 Withdrawn E201 PENSIONS SECTOR Certificate concerning the aggregation of periods of /11/95 insurance or periods of residence E202 Investigation of a claim for an old-age pension /11/95 E202 add pg 1 Item 12: "Children": Additional Information /11/95 E202 add pg 2 E202 add pg 3 Item 10.2: Additional Information for the purposes of the /11/95 Portuguese Additional Information for the purposes of the Norwegian /11/95 E202 add pg 4 Additional Information for the purposes of Swiss E202 add pg 5 Additional Information for the purposes of Polish E202 add pg 6 Additional Information for the purposes of Czech E202 add pg 7 Additional Information for the purposes of Lithuanian E202 add pg 8 Additional Information for the purposes of Belgian E202 add pg 9 Additional Information for the purposes of Latvian E203 Investigation of a claim for a survivor's pension /11/95 E203 add pg 1 Item 11: "Rightful claimants other than children": /11/95 Additional information for Italian E203 add pg 2 Item 15: "Children": Additional information /11/95 E203 add pg 3 Item 12 (12.8) : Additional information for the purposes of /11/95 Portuguese E203 add pg 4 Item 15: "Children": Additional information for the /11/95 purposes of Portuguese and Slovak E203 add pg 5 Additional information for the purposes of Norwegian /11/95 pensions sector.1.xls Last update: September 2006
8 E203 add pg 6 Item 11: Additional information for the purposes of /11/95 Swedish E203 add pg 7 Additional Information for Lithuanian E203 add pg 8 Additional information for Czech E203 add pg9 Item 8: Additional information for the needs of Slovak E203 add pg 10 Additional information for the purpose of Swiss E203 add pg 11 Additional Information for the purposes of Polish E203 add pg 12 Additional Information for the purposes of Belgian E203 add pg 13 Additional information for the purpose of Finnish - Item 11 Surviving Spouse E204 Investigation of a claim for an invalidity pension E204 add pg 1 Item 12: "Children": Additional information /11/95 E204 add pg 2 Item 9 (9.10): Additional information for the purposes of /11/95 Portuguese E204 add pg 3 Additional information for the purpose of Finnish /11/95 E204 add pg 4 Additional information for the purposes of Norwegian /11/95 E204 add pg 5 Additional information for the purpose of Swiss E204 add pg 6 Additional Information for Lithuanian E204 add pg 7 Additional Information for the purposes of Polish E204 add pg 8 Additional information for the purposes of Hungarian Withdrawn pensions sector.1.xls Last update: September 2006
9 E204 add pg 9 Additional Information for the purposes of Latvian E205BE Certificate concerning insurance history in Belgium /11/95 E205CZ E205DK Certificate concerning insurance history in the Czech Republic Certificate concerning periods of insurance and periods /11/95 of residence in Denmark E205DE Certificate concerning insurance history in Germany /11/95 E205EE Certificate concerning insurance history in the Estonian Republic E205GR Certificate concerning insurance history in Greece /11/95 E205ES Certificate concerning insurance history in Spain /11/95 E205FR Certificate concerning insurance history in France /11/95 E205IE Certificate concerning insurance history in Ireland /11/95 E205IT Certificate concerning insurance history in Italy /11/95 E205CY Certificate concerning insurance history in Cyprus E205LV Certificate concerning insurance history in Latvia E205LT Certificate concerning insurance history in Lithuania E205LU Certificate concerning insurance history in Luxembourg /11/95 E205HU Certificate concerning insurance history in Hungary E205MT Certificate concerning insurance history in Malta E205NL Certificate concerning insurance history in the /11/95 Netherlands Withdrawn pensions sector.1.xls Last update: September 2006
10 E205AT Certificate concerning insurance history in Austria /11/95 E205PL Certificate concerning insurance history in Poland E205PT Certificate concerning insurance history in Portugal /11/95 E205SI E205SK Certificate concerning insurance history in the Republic of Slovenia Certificate concerning insurance history in the Slovak Republic E205FI Certificate concerning insurance history in Finland /11/95 E205SE Certificate concerning insurance history in Sweden /11/95 E205UK Certificate concerning insurance history in the United /11/95 Kingdom E205IS Certificate concerning insurance history in Iceland /11/95 E205LI Certificate concerning insurance history in Liechenstein /11/95 E205NO Certificate concerning insurance history in Norway /11/95 E205CH E206 E207 Certificate concerning insurance history in Switzerland Certificate concerning periods of employment in mines /11/95 and similar undertakings Information concerning the insured person's insurance /11/95 history E207 add pg 1 Additional information for Swedish /11/95 E208 E209 Determination of entitlement to pension /10/85 L192 15/07/86 Determination of pension amounts regarding the possible application of article 46 (3) of Regulation /10/85 L192 15/07/86 Withdrawn /11/ /11/95 pensions sector.1.xls Last update: September 2006
11 E210 Notification of decision concerning a claim for pension /11/95 E211 Summary of decisions /11/95 E212 Appeals and periods allowed for appeals /11/95 E213 Detailed medical report /11/95 E213 add pg 1 E213 add pg 2 Additional information for the purposes of in /11/95 the Netherlands Additional information for the purposes of the United /11/95 Kingdom E213 add pg 3 Additional page for the purposes of Norwegian /11/95 E213 add pg 4 Additional Information for the purposes of Polish E213 add pg 5 E214 Additional information for the purposes of the Hungarian Medical report concerning assessment of functional abilities and limitations /11/95 E215 Administrative report on the position of a pensioner /11/95 E215 add pg 1 Additional information for the purposes of Norwegian /11/ /12/01 L304 6/11/02 corrigendum: L315 19/11/ /12/01 L304 6/11/02 corrigendum: L315 19/11/02 Withdrawn /02/00 L23 25/01/ /11/95 E501 Request for information on insurance history of a worker /07/82 C238 20/07/83 E502 Notification of registration /07/82 C238 20/07/83 pensions sector.1.xls Last update: September 2006
12 E503 Request for information on insurance history of a worker /04/83 C306 12/11/83 E504 Communication of insurance number of worker /04/83 C306 12/11/83 E505 Certificate concerning the insurance history of a worker /04/83 C306 12/11/83 E551 Notification of amendment /07/82 C238 20/07/ /10/03 L104 8/4/ /10/03 L104 8/4/04 Withdrawn /10/03 L104 8/4/04 pensions sector.1.xls Last update: September 2006
13 UNEMPLOYMENT SECTOR E301 E301 add E302 Certificate concerning the periods to be taken into account for the granting of unemployment benefits Additional information for Spanish - insurance periods and periods treated as such Certificate relating to members of the family of an unemployed person who must be taken into account for the calculation of benefits /02/ /02/ /02/94 E303/0 Certificate concerning retention of the right to unemployment benefits /02/94 E303/1 Certificate concerning retention of the right to unemployment benefits /02/94 E303/2 Certificate concerning retention of the right to unemployment benefits /02/94 E303/3 Certificate concerning retention of the right to unemployment benefits /02/94 E303/4 Certificate concerning retention of the right to unemployment benefits /02/94 E303/5 Information for unemployed persons who intend to go to another Member State to seek employment /02/94
14 E401 E-FORM Description Created by FAMILY BENEFITS Certificate concerning composition of a family for the /04/90 purpose of the granting of family benefits Withdrawn E402 E402 annex E403 E403 annex E404 E405 Certificate of continuation of studies for the purpose of /04/90 the granting of family benefits To be completed by school... if... submitted to a /04/90 Belgian institution Certificate of apprenticeship and/or vocational training for /04/90 the purpose of the granting of family benefits To be completed if... submitted to a French institution /04/90 and if it concerns... vocational training Medical certificate for the purpose of the granting of /04/90 family benefits Certificate concerning the aggregation of periods of /04/90 insurance, employment or self-employment or concerning successive employment in several Member States, between the dates on which payment is due...
15 E406F Certificate of post-natal medical examinations /04/90 E407 Medical certificate for the grant of a special family /04/90 allowance or of increased family allowances for handicapped children E407F E408 E408F Medical certificate for the grant of a special family /04/90 allowance or of increased family allowances for handicapped children Certificate of payment of family allowances in /04/90 accordance with former articles 73(2) and 74(2) - F Certificate of payment of family allowances in accordance with former articles 73(2) and 74(2) - F /04/90 E409 Certificate of payment or non-payment of benefits to selfemployed persons /06/90 L235 23/08/91 E409F E410F E411 E412F Verification of the declaration of lack of entitlement to /10/85 family allowances by virtue of an occupation pursued in L192 15/07/86 the country of residence of the family Notification of cancellation of entitlement to family allowances /10/85 L192 15/07/86 Request for information on entitlement to family benefits /10/90 in the Member States of residence of the members of the L235 23/08/91 family Certificate of payment of family allowances under the /10/90 former article 73(2) of regulation 1408/71 for the month L235 23/08/91 of November 1988 (to be filled in by the competent French institution responsible for granting family benefits) 144 9/04/ /04/90
16 E413F Certificate of payment or cessation of payment of family /10/90 allowances guaranteed under article 94(9) of regulation L235 23/08/ /71 (to be filled in by the competent French institution which has paid family benefits)
17 NON-CONTRIBUTORY BENEFITS E601 Request for information concerning the amount of income /04/93 received in a Member State other than the competent Member State E601B E601 Annex Belgique /04/93 E601E, L, UK E601 Annex Spain, Luxembourg, United Kingdom /04/93 E601F E601 Annex France /04/93 E602 Concerning the aggregation of periods of employment, of selfemployment or of residence /04/93
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