Income Form Childcare Fee For Pre-School - City Of Stockholm
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1
2
3City of Stockholm
Income Form
Childcare fee for pre-school
children and schoolchildren
1. The Child
Last name and first name
Personal ID number (10 digits)
2. Household
The information given must apply to the whole household of the child’s registrated address
Parent (person receiving bills)
Parent (cohabitee)
Last name
Last name
First name
Personal ID number (10 digits)
First name
Personal ID number (10 digits)
Phone no. home
Phone no. mobile
Phone no. home
Phone no. mobile
E-mail
E-mail
Street address
Post code and post town
Living circumstances
Living alone
Cohabiting
3. Household Income
Our household accepts maximum fee/our house-
If the income details requested are not provided, the maximum
hold income is 45 390 kr per month, or above
.
fee shall be charged in accordance with the applicable rate
Income relevant
Gross monthly amount
To be completed by administration
to the fee
(before tax)
Summa inkomst
Förvaltningsnummer
Parent (receiver
Parent
of bills)
(cohabitee)
Salary, remuneration, taxable
Skola
fringe benefits
Pension and temporary
disability benefit
Annuity and periodic support
Datum
Handläggare
Compensation from health and
accident insurance taken out in
connection with employment
Sickness benefit, rehabilitation
allowance, parental benefit and
taxable care allowance
Unemployment benefit
The fee will be charged for 12 months of the year. In the event
Taxable training allowance
of a default on payment, interest of 8% above the applicable
base rate will be charged on the overdue payment from the
Income from business activities
after deductions for social
due date. In the event of two unpaid monthly bills, there is
security contribution
cause for cancellation of the child’s place after the usual
reminder procedure has been carried out.
Date
Date
The information applies from
Cause for irregular income (see appendix for explanation)
4.
Irregular income
Note: household income above
needs to be estimated
Affirmation and signature
I hereby affirm that the information provided on the form is correct. I am aware of my obligation to report any changes which may affect the fee
immediately. I agree to checks being carried out by the Swedish social insurance agency, the employment office and the tax authority. I have
taken note of and accept the conditions of payment as indicated above.
Parent (receiver of bills)
Parent (cohabitee)
Date
Signature
Date
Signature
The information provided shall be handled in accordance with the Swedish personal data act.
See appendix for more information on how to fill in this form and main regualtions concerning the fee.
The form is to be sent to Serviceförvaltningen, Ekonomi, Förskole- och fritidshemsavgifter, Box 7005, 121 07 Stockholm.
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