Docstoc

716103 e Arbeitgeberbescheinigung

Document Sample
716103 e Arbeitgeberbescheinigung Powered By Docstoc
					                Unemployment insurance                                                    Date of receipt

                Employer’s certificate

                Surname and first name                                                     Personnel no.     AHV (Swiss old age and survivors’
                                                                                                             insurance no.)

                Postcode, town, street, number                                                   Date of birth          Marital status


                Employers are required to provide truthful information and must maintain confidentiality vis-à-vis third parties (Art. 20,
                88 AVIG; Art. 28 ATSG); they must in particular deliver the employer’s certificate to the insured person within a week of
                said person’s request.

                Form of employment            The form of employment immediately before leaving employment is decisive in answering
                                              the following questions.
                1      Type of employment               Fixed-term             Permanent
                          Full-time job                 Temping/agency work    On-call job                Work scheme for
                          Part-time job                 Seasonal job           Temporary employment       unemployed persons
                          Teleworking / working         Apprenticeship
                          from home

                2      Length of employment             from                                     to

                3      Employed as

                4      Does the insured person or his/her spouse or registered partner have a share in the business or hold a managerial
                       position (e.g. shareholder, board of directors in a plc or partner or MD in a private limited company, etc.) ?
                                                                                                                        yes      no

                5      Normal working hours in the business                             Hours per week

                6      The insured person’s normal contractual working hours            Hours per week

                7      Was there a written employment contract?      yes        no

                8      Was employment subject to a collective employment agreement?
                         yes    CEA                                                                                                       no

                9      Which AHV compensation fund is the company affiliated to?
                       (Name and number)

                Termination of employment

                10 Who gave notice?                                    When?                           For what date of
                     verbally       in writing (attach written notice)                                 termination?

                11 Duration of the statutory or contractual notice period?

                12 Was the insured person unable to work due to illness, accident, pregnancy, military service, civil protection or
                   civilian service at the time notice was given or during the notice period?
                                                                                                                                               716.103 e




                       yes, due to                                       from                 to                                no
                                                                                                                                               6.2008




                     13 Reason for notice          ______________________________________________________________
0716103 – 004 – 06




                                    _____________________________________________________________________________
                                    _____________________________________________________________________________
     - 2008




                                    _____________________________________________________________________________
14 Last day worked

15 Wages were paid until

Periods of employment in the last 2 years

16 Use a new line for each period of employment that follows a break in employment of at least one month.
    from             to                  Total earnings subject to AHV
                                         contributions
                                         CHF
                                               CHF
                                               CHF
                                               CHF


17 Earnings
       THE PAY SLIPS OR PAYROLL REGISTERS OF THE LAST 12 MONTHS MUST BE INCLUDED WITH THE
       EMPLOYER’S CERTIFICATE

       Last monthly wages                  CHF

       - The last time the ensured person received
         a 13th monthly wage of CHF              was on
         a bonus             of CHF              was on

                                            Basic wage/          Vacation pay     Holiday pay       13th monthly   Total hourly
       Last hourly wages:
                                               hours                                                wage / bonus      wages
                                           CHF                              %                   %               % CHF

18 Absences

        Absences during the last 12
                                           from             to             from         to              from       to
        months on account of
        Illness
        Accident
        Swiss military service, civil
        protection or civilian service
        Unpaid vacation
        Other reasons

19 Is an annuity or pension being paid?               yes        CHF                    per month                            no
   (attach supporting documents)

20 What pension fund are employees ensured with under the Federal Act
   on Occupational Old Age, Survivors' and Invalidity Pension Provision?

21 On termination of employment, did you grant the insured person further financial benefits in addition to wage
   entitlements?
      yes CHF                (attach supporting documents)                                                                        no

22 Were child and/or training allowances paid?
          yes     Number of child allowances                      Number of training allowances                                   no


Place and date:                                                   Complete address / Valid signature / Company stamp

         and

Tel.

Attached copies:                   Letter of notice
                                   Pay slips for the last 12 months (section 17)
                                   Supporting documents according to sections 19 + 21

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:155
posted:7/22/2010
language:English
pages:2