Information form for payment of child and youth benefits for citizens
Send to Udbetaling Danmark Kongens Vænge 8 3400 Hillerød A. Your information Family benefits Information form for payment of child and youth benefits for citizens of EU/EEA countries and Switzerland Danish civil registration (CPR) number Name Address in Denmark Postcode and city in Denmark Foreign address - current or most recent address Foreign postcode and city Country ID number in this country Citizenship Telephone number Please complete the form on the following pages, and enclose the following documentation Information form – completed and signed Copy of the child’s birth certificate (not applicable if the child has a Danish birth certificate) Enclose a copy of your employment contract(s) if you are: • an employee • seconded abroad by a public-sector company • working on a ship Copy of any decision on social security/A1 form if you are: • seconded abroad by a private-sector company • employed as a pilot or cabin crew • working in several countries If you work offshore in the Danish part of the North Sea, please enclose the following documentation: • Your employment certificate • Confirmation from your employer concerning working periods in Danish waters • Your international bank account number • Copy of your passport side 1 af 5 09/15 B. Employment details B1. If you are employed I am a salaried employee I am self-employed I work as a pilot or cabin crew I work on a ship or offshore I am a public-sector employee seconded abroad I am seconded for a private-sector company Where is the work carried out in practice? in Denmark abroad both in Denmark and abroad Employer/company details Name of the company Central business registration number or RUT (Register of Foreign Service Providers) no. Company address Country Employment/self-employment start date Employment period (if for a limited period) Number of working hours per month in Denmark If you are self-employed, please describe in which sector If you are self-employed, please describe your work tasks B2. If you are uemployed Do you receive other benefits from the Danish state Yes No if yes, please specify which benefits Maternaty/paternity benefits Sick pay Unemployment benefits Early retirement pension Pension Education grant from the Danish state (SU) Welfare benefits Other ___________________________________________ Benefit start date: ___________________________________________ Do you receive one of the above benefits from a country/-ies abroad? Yes If yes, please specify which benefits Benefit start date No C. Information about the child Name Danish civil reg. (CPR) number or date of birth Address in Denmark Postcode and city in Denmark Foreign address - current or most recent address Foreign postcode and city Country ID number in this country Child’s gender Boy Girl Custody of the child Mother Father Joint custody Other Yes, abroad Yes, in Denmark No Do you live in the same household as the child? side 2 af 5 09/15 D. Information about the child’s other parent Name Danish civil reg. (CPR) number or date of birth Address in Denmark Postcode and city in Denmark Foreign address - current or most recent address Foreign postcode and city Country ID number in this country Citizenship Employment detalis: Salaried employee or self-employed in ______________________________(specify country) Recieve unemployment/sickness/maternaty benefits from ______________________(specify country) Seconded by public-sector or private-sector comoany in _____________________________(specify country) Recieve pension from ________________________________(specify country) Not working (e.g. student, work in the home) Other ______________________________________________ E. Your relationship with the child’s other parent Married Cohabitant Divorced Other _____________________________ Do not live with the child’s other parent (neither in Denmark nor abroad) F. Supplementary information about residence and employment in EU/EEA countries, Switzerland, Greenland or the Faroe Islands within the past ten years. Have you and/or the child’s other parent lived and/or worked in an EU/EEA country, Switzerland, Greenland or the Faroe Islands within the past ten years? Yes No If yes, please specify Your periods of residence and employment: Country ID number in this country Most recent address in this country Period of residence (year(s), from-to) Period of employment (year(s), from-to) Country ID number in this country Most recebt address in this country Period of residence (year(s), from-to) Period of employment (year(s), from-to) side 3 af 5 09/15 Other parent’s periods of residence and employment: Country ID numer in this country Most recent address in this country Period of residence (year(s), from-to) Period of employment (year(s), from-to) Country ID number in this country Most recent address in this country Period of residence (year(s), from-to) Period of employment (year(s), from-to) G. Other information Do you receive family benefits from another EU/EEA country or Switzerland Yes No If yes, please specify: Country Foreign authority Monthly amount Most recent payment was for (specify month) File no. of foreign case Any other information H. Payment to Nemkonto (automatically assigned personal bank account) Do you have a NemKonto? Yes No In order for us to be able to pay the money to you, you must set up a NemKonto with your bank. You can also set up a foreign NemKonto account. See more at www.nemkonto.dk/borger.dk J. Declaration, consent and signature I declare that the information I have provided is correct and that I am aware of the following: • Date I am obliged to help procure information in the matter and notify Udbetaling Danmark immediately of any changes in the information provided which may affect my entitlement to the benefit. • I consent to Udbetaling Danmark obtaining information from employers, unemployment funds, local authorities and other public authorities in Denmark and abroad. Signature Remenber to submit all the necessary documents - see the front page side 4 af 5 09/15 Information Information form The form must be sent to Udbetaling Danmark so that we can determine whether your child is entitled to child and youth benefits from Denmark, or whether you are entitled to any benefits for your child form another country. You must provide the information necessary to enable Udbetaling Danmark to determine which benefit you can get. If you do not help Udbetaling Danmark by providing the information we need, your case will be processed on the basis of the information we have. Potentialle, this may mean that you will be granted a lower benefit than what you applied for. Payouts If you are entitled to child and youth benefits from Denmark, the benefits will be paid out via your personal bank account, NemKonto. You must therefore establish a NemKonto if you do not already have one. Duty of disclosure You must notify us immediately of any changes that have an impact on your right to receive child and youth benefits, including changes in your og your child’s family situation. For example, it makes a difference if you move to another country, or if the child is being maintained by means of public benefits. You must also let us know if you get a job in another country or stop working in Denmark. Repayment If you provide incorrect information or fail to inform us of relevant changes, you may be required to repay the child and youth benefits. If you, through gross negligence or intentionally, provide incorrect og misleading information, the courts may impose a fine under section 14 of the Danish Act on Udbetaling Danmark (Udbetaling Danmark-loven), or you may beliable to a fine or imprisonment under section 7 of the Danish Child and Youth Benefit Act (Lov om en børne- og ungeydelse) or under the provisions set out in the Danish Criminal Code (Straffeloven). Udbetaling Danmark checks To check whether you are entitled to a specific benefit, Udbetaling Danmark may, without your consent, obtain and correlate necessary non-sensitive personal data from other public authorities and unemployment funds. Correlation may take place with data from Udbetaling Danmark’s own registers. If the correlation reveals information that is necessary for the municipality’s check, Udbetaling Danmark is required to disclose such information to the municipality. The municipality and Udbetaling Danmark may, without your consent, exchange information for use in connection with adustments, recalculations, deductions or setoffs or for performing other types of follow-up and for checking cases of misuse in relation to the payment of benefits. If necessary for processing a case on the repayment of benefits, Udbetaling Danmark may, without your consent, obtain information from other authorities, employers, banks etc. The municipality has access to a business’s premises in order to check the wage/salary payments that form the basis of social or occupational benefits. If, in this context, the municipality obtains information which is important for Udbetaling Danmark’s check of wether there has been any cases of misuse in relation to the payment of benefits, the municipality must disclose this information to Udbetaling Danmark. Registration You have the right to know what information Udbetaling Danmark has registered about you. You may demand that we correct any incorrect information. Further information If you need further information, you are welcome to contact Udbetaling Danmark. You can also read more about the child and youth benefits at www.borger.dk/familieydelser. Legal framework Sections 10-12 of the Danish Consolidation Act on Legal Protection and Administration in Social Matters (Lov om retssikkerhed og administration på det sociale område), 5(5) of the Danish Child and Youth Benefit Act, parts 9 and 10 of the Danish Act on Processing of Personal Data (Persondataloven) and sections 4-12 of the Danish Act on Udbetlaing Danmark. Articles 11-16 and Article 68 of Regulation (EC) 883/2004. You can find more information at www.retsinfo.dk. side 5 af 5 09/15
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