GENERAL E001 Request for information, communication of information, request for forms, 153 07/10/93 reminder on an employed person, self-employed person, a frontier worker, a pensioner, an unemployed person, a dependant.
POSTING E101 Certificate concerning the legislation applicable 164 27/11/96 L216 08/08/97 172 9/12/98 L143 8/6/99 corrigendum: L159 25/6/99 p.67 186 27/06/02 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 164 27/11/96 L216 08/08/97
HEALTHCARE SECTOR E103 Exercising the right of option 153 07/10/93 E104 E105 Certificate concerning the aggregation of periods of 153 07/10/93 insurance, employment or residence Certificate concerning the members of the family of an 153 07/10/93 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 153 07/10/93 insurance benefits in kind for persons residing in a country other than the competent country 166 02/10/97 L195 11/07/98 Withdrawn E107 E108 Application for a certificate of entitlement to benefits in 153 07/10/93 kind Notification of suspension or withdrawal of the right to 153 07/10/93 sickness and maternity insurance benefits in kind 185 27/06/02 L55 1/03/2003 E109 Certificate for the registration of members of the 153 07/10/93 employed or self-employed person's family and the updating of lists 166 02/10/97 L195 11/07/98 E110 Certificate concerning employed persons in international transport 153 07/10/93 198 23/03/04 L259 05/08/04
E111 Certificate of entitlement to benefits in kind during a stay in a Member State 153 07/10/93 187 27/06/02 L93 10/04/03 198 23/03/04 L259 05/08/04 191 18/06/03 L276 7/10/03 E111B For hospitalisation only - Certificate of entitlement to 153 07/10/93 benefits in kind during a stay in a Member State - Scheme for self-employed persons 187 27/06/02 L93 10/04/03 191 18/06/03 L276 7/10/03 E112 Certificate concerning the retention of the right to 153 07/10/93 sickness or maternity benefits currently being provided E113 Hospitalisation: notification of entering and leaving hospital 153 07/10/93 198 23/03/04 L259 05/08/04 E114 Granting of major benefits in kind 153 07/10/93 198 23/03/04 L259 05/08/04 E115 Claim for cash benefits for incapacity for work 153 07/10/93 E116 E117 E118 Medical report relating to incapacity for work (sickness, maternity, accident at work, occupational disease) 153 07/10/93 Granting of cash benefits in the case of maternity and 153 07/10/93 incapacity for work Notification of non-recognition or of end of incapacity for 153 07/10/93 work
E118 Annex Legal remedies and periods allowed for appeals 153 07/10/93 E119 E120 E121 Certificate concerning the entitlement of unemployed 153 07/10/93 persons and the members of their family to sickness and maternity insurance benefits Certificate of entitlement to benefits in kind for pension 153 07/10/93 claimants and members of their family Certificate for the registration of pensioners and the 153 07/10/93 updating of lists 198 23/03/04 L259 5/08/04 168 11/06/98 L195 11/07/98 E122 Certificate for the granting of benefits in kind to members of the family of pensioners 153 07/10/93 E123 Certificate of entitlement to benefits in kind under 153 07/10/93 insurance against accidents at work and occupational diseases E124 Claim for death grant 153 07/10/93 E124 additional Additional information for the purposes of Portuguese 153 07/10/93 E125 Individual record of actual expenditure 153 07/10/93 E125A additional Additional information for the purposes of Norwegian 153 07/10/93 168 11/06/98 L195 11/07/98 153 07/10/93 E126 Rates for refund of benefits in kind 153 07/10/93
E127 Individual record of monthly lump-sum payments 153 07/10/93 168 11/06/98 L195 11/07/98 E128 Certificate of entitlement to necessary benefits in kind during a stay in a Member State 165 30/06/97 L341 12/12/97 168 11/06/98 L195 11/07/98 177 5/10/99 L302 1/12/00 198 23/03/04 L259 05/08/04 E128B Certificate of entitlement to necessary benefits in kind 165 30/06/97 during a stay in a Member State : for hospitalisation only L341 12/12/97 - scheme for self-employed persons 177 5/10/99 L302 1/12/00 198 23/03/04 L259 05/08/04
Withdrawn E201 PENSIONS SECTOR Certificate concerning the aggregation of periods of 158 27/11/95 insurance or periods of residence E202 Investigation of a claim for an old-age pension 158 27/11/95 E202 add pg 1 Item 12: "Children": Additional Information 158 27/11/95 E202 add pg 2 E202 add pg 3 Item 10.2: Additional Information for the purposes of the 158 27/11/95 Portuguese Additional Information for the purposes of the Norwegian 158 27/11/95 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 158 27/11/95 E203 add pg 1 Item 11: "Rightful claimants other than children": 158 27/11/95 Additional information for Italian E203 add pg 2 Item 15: "Children": Additional information 158 27/11/95 E203 add pg 3 Item 12 (12.8) : Additional information for the purposes of 158 27/11/95 Portuguese E203 add pg 4 Item 15: "Children": Additional information for the 158 27/11/95 purposes of Portuguese and Slovak E203 add pg 5 Additional information for the purposes of Norwegian 158 27/11/95 pensions sector.1.xls Last update: September 2006
E203 add pg 6 Item 11: Additional information for the purposes of 158 27/11/95 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 158 27/11/95 E204 add pg 2 Item 9 (9.10): Additional information for the purposes of 158 27/11/95 Portuguese E204 add pg 3 Additional information for the purpose of Finnish 158 27/11/95 E204 add pg 4 Additional information for the purposes of Norwegian 158 27/11/95 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
E204 add pg 9 Additional Information for the purposes of Latvian E205BE Certificate concerning insurance history in Belgium 158 27/11/95 E205CZ E205DK Certificate concerning insurance history in the Czech Republic Certificate concerning periods of insurance and periods 158 27/11/95 of residence in Denmark E205DE Certificate concerning insurance history in Germany 158 27/11/95 E205EE Certificate concerning insurance history in the Estonian Republic E205GR Certificate concerning insurance history in Greece 158 27/11/95 E205ES Certificate concerning insurance history in Spain 158 27/11/95 E205FR Certificate concerning insurance history in France 158 27/11/95 E205IE Certificate concerning insurance history in Ireland 158 27/11/95 E205IT Certificate concerning insurance history in Italy 158 27/11/95 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 158 27/11/95 E205HU Certificate concerning insurance history in Hungary E205MT Certificate concerning insurance history in Malta E205NL Certificate concerning insurance history in the 158 27/11/95 Netherlands Withdrawn pensions sector.1.xls Last update: September 2006
E205AT Certificate concerning insurance history in Austria 158 27/11/95 E205PL Certificate concerning insurance history in Poland E205PT Certificate concerning insurance history in Portugal 158 27/11/95 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 158 27/11/95 E205SE Certificate concerning insurance history in Sweden 158 27/11/95 E205UK Certificate concerning insurance history in the United 158 27/11/95 Kingdom E205IS Certificate concerning insurance history in Iceland 158 27/11/95 E205LI Certificate concerning insurance history in Liechenstein 158 27/11/95 E205NO Certificate concerning insurance history in Norway 158 27/11/95 E205CH E206 E207 Certificate concerning insurance history in Switzerland Certificate concerning periods of employment in mines 158 27/11/95 and similar undertakings Information concerning the insured person's insurance 158 27/11/95 history E207 add pg 1 Additional information for Swedish 158 27/11/95 E208 E209 Determination of entitlement to pension 130 17/10/85 L192 15/07/86 Determination of pension amounts regarding the possible application of article 46 (3) of Regulation 130 17/10/85 L192 15/07/86 Withdrawn 158 27/11/95 158 27/11/95 pensions sector.1.xls Last update: September 2006
E210 Notification of decision concerning a claim for pension 158 27/11/95 E211 Summary of decisions 158 27/11/95 E212 Appeals and periods allowed for appeals 158 27/11/95 E213 Detailed medical report 158 27/11/95 E213 add pg 1 E213 add pg 2 Additional information for the purposes of in 158 27/11/95 the Netherlands Additional information for the purposes of the United 158 27/11/95 Kingdom E213 add pg 3 Additional page for the purposes of Norwegian 158 27/11/95 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 158 27/11/95 E215 Administrative report on the position of a pensioner 158 27/11/95 E215 add pg 1 Additional information for the purposes of Norwegian 158 27/11/95 184 10/12/01 L304 6/11/02 corrigendum: L315 19/11/02 184 10/12/01 L304 6/11/02 corrigendum: L315 19/11/02 Withdrawn 180 15/02/00 L23 25/01/01 158 27/11/95 E501 Request for information on insurance history of a worker 117 07/07/82 C238 20/07/83 E502 Notification of registration 117 07/07/82 C238 20/07/83 pensions sector.1.xls Last update: September 2006
E503 Request for information on insurance history of a worker 118 20/04/83 C306 12/11/83 E504 Communication of insurance number of worker 118 20/04/83 C306 12/11/83 E505 Certificate concerning the insurance history of a worker 118 20/04/83 C306 12/11/83 E551 Notification of amendment 117 07/07/82 C238 20/07/83 192 29/10/03 L104 8/4/04 192 29/10/03 L104 8/4/04 Withdrawn 192 29/10/03 L104 8/4/04 pensions sector.1.xls Last update: September 2006
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 154 08/02/94 154 08/02/94 154 08/02/94 E303/0 Certificate concerning retention of the right to unemployment benefits 154 08/02/94 E303/1 Certificate concerning retention of the right to unemployment benefits 154 08/02/94 E303/2 Certificate concerning retention of the right to unemployment benefits 154 08/02/94 E303/3 Certificate concerning retention of the right to unemployment benefits 154 08/02/94 E303/4 Certificate concerning retention of the right to unemployment benefits 154 08/02/94 E303/5 Information for unemployed persons who intend to go to another Member State to seek employment 154 08/02/94
E401 E-FORM Description Created by FAMILY BENEFITS Certificate concerning composition of a family for the 144 09/04/90 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 144 09/04/90 the granting of family benefits To be completed by school... if... submitted to a 144 09/04/90 Belgian institution Certificate of apprenticeship and/or vocational training for 144 09/04/90 the purpose of the granting of family benefits To be completed if... submitted to a French institution 144 09/04/90 and if it concerns... vocational training Medical certificate for the purpose of the granting of 144 09/04/90 family benefits Certificate concerning the aggregation of periods of 144 09/04/90 insurance, employment or self-employment or concerning successive employment in several Member States, between the dates on which payment is due...
E406F Certificate of post-natal medical examinations 144 09/04/90 E407 Medical certificate for the grant of a special family 144 09/04/90 allowance or of increased family allowances for handicapped children E407F E408 E408F Medical certificate for the grant of a special family 144 09/04/90 allowance or of increased family allowances for handicapped children Certificate of payment of family allowances in 144 09/04/90 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 144 09/04/90 E409 Certificate of payment or non-payment of benefits to selfemployed persons 145 27/06/90 L235 23/08/91 E409F E410F E411 E412F Verification of the declaration of lack of entitlement to 130 17/10/85 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 130 17/10/85 L192 15/07/86 Request for information on entitlement to family benefits 147 10/10/90 in the Member States of residence of the members of the L235 23/08/91 family Certificate of payment of family allowances under the 146 10/10/90 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 9/04/90 144 9/04/90
E413F Certificate of payment or cessation of payment of family 146 10/10/90 allowances guaranteed under article 94(9) of regulation L235 23/08/91 1408/71 (to be filled in by the competent French institution which has paid family benefits)
NON-CONTRIBUTORY BENEFITS E601 Request for information concerning the amount of income 151 22/04/93 received in a Member State other than the competent Member State E601B E601 Annex Belgique 151 22/04/93 E601E, L, UK E601 Annex Spain, Luxembourg, United Kingdom 151 22/04/93 E601F E601 Annex France 151 22/04/93 E602 Concerning the aggregation of periods of employment, of selfemployment or of residence 151 22/04/93