Request For Certificate Pd U1/n-301 For Coordination Of Social Security
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Request for certificate PD U1/N-301
for coordination of social security
Reg 883/2004 art 61 and 62, and reg 987/2009 art 54 (1 and 2).
Please write in CAPITAL letters if you fill out by hand
1. THE COUNTRY WHERE PD U1/N-301 WILL BE USED
Certificate PD U1/N-301 from Norway is used when applying for unemployment benefit in another EEA country.
Each EEA country decides the period for which a certificate is required. Before you apply, ask the authorities in the country where you
will be applying for unemployment benefit about their required period.
In which EEA country will you be using the certificate?
2. PERSONAL INFORMATION
Surname
First name
Address
E-mail
Post code
Town
Country
Norwegian social security number (11 digits)
Foreign social security number
Citizenship
Telephone number/mobile number
Moved to Norway
Moved / departure date from Norway
3. EMPLOYER(S)
If you have worked a rota system, state the final day of the rota. If you have worked as an on-call assistant/substitute, attach time sheets.
Employer
Address
Telephone number
Worked from (dd.mm.yy)
Worked to (dd.mm.yy)
Occupation/title
Weekly working hours
Hourly wage
Cause of termination
Dismissed
Employment contract expired
Resigned
Other cause:
Use the fields below if you have had more than one employer
Employer
Address
Telephone number
Worked from (dd.mm.yy)
Worked to (dd.mm.yy)
Occupation/title
Weekly working hours
Hourly wage
Cause of termination
Dismissed
Employment contract expired
Resigned
Other cause:
Employer
Address
Telephone number
Worked from (dd.mm.yy)
Worked to (dd.mm.yy)
Occupation/title
Weekly working hours
Hourly wage
Cause of termination
Dismissed
Employment contract expired
Resigned
Other cause:
NAV 04-02.05 Engelsk Fastsatt 07.2006 Endret 05.2013 PDF-versjon
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