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<?xml version="1.0" encoding="utf-8"?>
<tmx version="1.4">
<header adminlang="en" creationdate="20170629T094754Z" creationid="TLDJanisS\janis.slapins" creationtool="Tilde Plaintext-to-TMX Converter" creationtoolversion="1.0" datatype="plaintext" o-tmf="Moses file pair" segtype="sentence" srclang="en">
<prop type="x-tucount">287</prop>
</header>
<body>
<tu tuid="1">
<tuv xml:lang="en">
<seg>Your case has been sent to the county administrative court [förvaltningsrätten] in which will consider it.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Votre dossier a été transmis au Tribunal administratif départemental [förvaltningsrätten] de , qui en connaîtra.</seg>
</tuv>
</tu>
<tu tuid="2">
<tuv xml:lang="en">
<seg>Please contact the county administrative court if you require further information.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pour toutes questions relatives à votre dossier, adressez-vous au Tribunal administratif départemental.</seg>
</tuv>
</tu>
<tu tuid="3">
<tuv xml:lang="en">
<seg>Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="4">
<tuv xml:lang="en">
<seg>Jessica Selander</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jessica Selander</seg>
</tuv>
</tu>
<tu tuid="5">
<tuv xml:lang="en">
<seg>Date of birth:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date de naissance:</seg>
</tuv>
</tu>
<tu tuid="6">
<tuv xml:lang="en">
<seg>It is hereby certified that X date of birth X has a Swedish sickness compensation.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je soussigné/e certifie que X né/e le X perçoit une indemnité maladie suédoise.</seg>
</tuv>
</tu>
<tu tuid="7">
<tuv xml:lang="en">
<seg>The annual amount for X is X Swedish kronor.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Le montant annuel pour l’an X s’élève à X couronnes suédoises.</seg>
</tuv>
</tu>
<tu tuid="8">
<tuv xml:lang="en">
<seg>Deduction for tax is X Swedish kronor.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La retenue à la source est de X couronnes suédoises.</seg>
</tuv>
</tu>
<tu tuid="9">
<tuv xml:lang="en">
<seg>The tax-free part, the “exempt” amount is X Swedish kronor.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La fraction exonérée d’impôt, dite franchise, s’élève à X couronnes suédoises.</seg>
</tuv>
</tu>
<tu tuid="10">
<tuv xml:lang="en">
<seg>Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="11">
<tuv xml:lang="en">
<seg>Jessica Selander</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jessica Selander</seg>
</tuv>
</tu>
<tu tuid="12">
<tuv xml:lang="en">
<seg>Försäkringskassan [The Swedish Social Insurance Agency] has decided not to pay your from and including .</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Försäkringskassan [l’Agence suédoise de la sécurité sociale] a décidé de ne plus verser votre pension ou toute autre prestation à compter du .</seg>
</tuv>
</tu>
<tu tuid="13">
<tuv xml:lang="en">
<seg>Description of the case</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Description du dossier</seg>
</tuv>
</tu>
<tu tuid="14">
<tuv xml:lang="en">
<seg>Försäkringskassan has granted you .</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous percevez une pension ou une autre prestation versée par Försäkringskassan.</seg>
</tuv>
</tu>
<tu tuid="15">
<tuv xml:lang="en">
<seg>Since you live outside Sweden, you must show that you are still entitled to the benefit.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Comme vous résidez hors de Suède, vous êtes tenu/e de prouver que vous avez toujours le droit de percevoir cette prestation.</seg>
</tuv>
</tu>
<tu tuid="16">
<tuv xml:lang="en">
<seg>You do this by sending us a life certificate.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous le faites en nous envoyant un certificat de vie.</seg>
</tuv>
</tu>
<tu tuid="17">
<tuv xml:lang="en">
<seg>Reasoning</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Motifs</seg>
</tuv>
</tu>
<tu tuid="18">
<tuv xml:lang="en">
<seg>The payments have ceased because you have not submitted a correctly completed life certificate.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Les versements cesseront parce que vous n’avez pas envoyé un certificat de vie complet à Försäkringskassan.</seg>
</tuv>
</tu>
<tu tuid="19">
<tuv xml:lang="en">
<seg>A life certificate shall be made on the designated form and it shall be certified by one of the authorities stated below:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pour prouver que vous êtes en vie, il faut remplir le formulaire prescrit et faire attester ce certificat de vie par une des autorités ou institutions suivantes:</seg>
</tuv>
</tu>
<tu tuid="20">
<tuv xml:lang="en">
<seg>• Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="21">
<tuv xml:lang="en">
<seg>• A Swedish embassy</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• une ambassade suédoise</seg>
</tuv>
</tu>
<tu tuid="22">
<tuv xml:lang="en">
<seg>• A Swedish consulate</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• un consulat suédois</seg>
</tuv>
</tu>
<tu tuid="23">
<tuv xml:lang="en">
<seg>• A foreign social insurance institution</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• un organisme étranger de sécurité sociale</seg>
</tuv>
</tu>
<tu tuid="24">
<tuv xml:lang="en">
<seg>• A foreign police authority</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• un notaire public</seg>
</tuv>
</tu>
<tu tuid="25">
<tuv xml:lang="en">
<seg>• A foreign authority responsible for population registration.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• un service de police étranger</seg>
</tuv>
</tu>
<tu tuid="26">
<tuv xml:lang="en">
<seg>• Chapter 110, section 15 of the Swedish Social Insurance Code</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• le chap. 110 art. 15 du code de la sécurité sociale suédoise</seg>
</tuv>
</tu>
<tu tuid="27">
<tuv xml:lang="en">
<seg>• Försäkringskassan’ Regulations (2006:2) on Life Certificates</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• les prescriptions de Försäkringskassan (2006:2) relatives au certificat de vie.</seg>
</tuv>
</tu>
<tu tuid="28">
<tuv xml:lang="en">
<seg>Are you unsatisfied with the decision?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous n’êtes pas satisfait de la décision ?</seg>
</tuv>
</tu>
<tu tuid="29">
<tuv xml:lang="en">
<seg>Read more about your options on the next page.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Lisez sur la page suivante ce que vous pouvez faire.</seg>
</tuv>
</tu>
<tu tuid="30">
<tuv xml:lang="en">
<seg>Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="31">
<tuv xml:lang="en">
<seg>Jessica Selander</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jessica Selander</seg>
</tuv>
</tu>
<tu tuid="32">
<tuv xml:lang="en">
<seg>Are you not satisfied with the decision?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous n’êtes pas satisfait de la décision ?</seg>
</tuv>
</tu>
<tu tuid="33">
<tuv xml:lang="en">
<seg>If you consider that this decision is wrong you can request that Försäkringskassan shall reconsider it.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Si vous estimez que cette décision n'est pas juste, vous pouvez demander que la Försäkringskassan la réexamine.</seg>
</tuv>
</tu>
<tu tuid="34">
<tuv xml:lang="en">
<seg>If this is the case, write a letter to Försäkringskassan.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Dans ce cas, vous devez écrire une lettre à la Försäkringskassan.</seg>
</tuv>
</tu>
<tu tuid="35">
<tuv xml:lang="en">
<seg>The letter must be received within two months of the day of your getting information about the decision.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La lettre doit parvenir à la Försäkringskassan dans un délai de deux mois à partir du jour où vous avez été avisé de la décision.</seg>
</tuv>
</tu>
<tu tuid="36">
<tuv xml:lang="en">
<seg>It must contain the following information:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Elle devra contenir les renseignements suivants:</seg>
</tuv>
</tu>
<tu tuid="37">
<tuv xml:lang="en">
<seg>• Which decision you would like to be reconsidered.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• Quelle est la décision qui doit être réexaminée.</seg>
</tuv>
</tu>
<tu tuid="38">
<tuv xml:lang="en">
<seg>• How and why you would like the decision changed.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• Dans quel sens et pourquoi désirez-vous que la décision soit modifiée.</seg>
</tuv>
</tu>
<tu tuid="39">
<tuv xml:lang="en">
<seg>• Your name, Swedish personal identity number, address and telephone number.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>• Votre nom, numéro personnel d'identité, adresse et numéro de téléphone.</seg>
</tuv>
</tu>
<tu tuid="40">
<tuv xml:lang="en">
<seg>If you employ a deputy, there must be a power of attorney.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Si vous avez recours à un représentant, un pouvoir en original devra être joint à la demande.</seg>
</tuv>
</tu>
<tu tuid="41">
<tuv xml:lang="en">
<seg>The request for reconsideration shall be sent to Försäkringskassan, OMP – SA, , Sweden.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La demande de réexamen doit être adressée à la Försäkringskassan, OMP – SA, , Suède.</seg>
</tuv>
</tu>
<tu tuid="42">
<tuv xml:lang="en">
<seg>Do you have any questions?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Si vous avez des questions à poser</seg>
</tuv>
</tu>
<tu tuid="43">
<tuv xml:lang="en">
<seg>You are welcome to call our customer centre at +46 771-524 524 if you have any questions about your case.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous pouvez téléphoner à notre Service clientèle au +46 771-524 524, si vous avez des questions à poser concernant votre affaire.</seg>
</tuv>
</tu>
<tu tuid="44">
<tuv xml:lang="en">
<seg>1.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>1.</seg>
</tuv>
</tu>
<tu tuid="45">
<tuv xml:lang="en">
<seg>State your most recent employment in your country of residence</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Indiquez votre dernière situation de travail dans votre pays de résidence</seg>
</tuv>
</tu>
<tu tuid="46">
<tuv xml:lang="en">
<seg>a.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>a.</seg>
</tuv>
</tu>
<tu tuid="47">
<tuv xml:lang="en">
<seg>Occupation/employment:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Profession/activité:</seg>
</tuv>
</tu>
<tu tuid="48">
<tuv xml:lang="en">
<seg>b.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>b.</seg>
</tuv>
</tu>
<tu tuid="49">
<tuv xml:lang="en">
<seg>Working hours per week:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Horaire par semain:</seg>
</tuv>
</tu>
<tu tuid="50">
<tuv xml:lang="en">
<seg>c.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>c.</seg>
</tuv>
</tu>
<tu tuid="51">
<tuv xml:lang="en">
<seg>Wage per month:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Salaire mensuel:</seg>
</tuv>
</tu>
<tu tuid="52">
<tuv xml:lang="en">
<seg>d.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>d.</seg>
</tuv>
</tu>
<tu tuid="53">
<tuv xml:lang="en">
<seg>Last working day:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Dernier jour de travail:</seg>
</tuv>
</tu>
<tu tuid="54">
<tuv xml:lang="en">
<seg>2.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>2.</seg>
</tuv>
</tu>
<tu tuid="55">
<tuv xml:lang="en">
<seg>Do you have or have you had any of the following benefits?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Percevez-vous ou avez-vous perçu une des prestations suivantes?</seg>
</tuv>
</tu>
<tu tuid="56">
<tuv xml:lang="en">
<seg>Sickness benefit</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Indemnité journalière de maladie</seg>
</tuv>
</tu>
<tu tuid="57">
<tuv xml:lang="en">
<seg>time period:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>période:</seg>
</tuv>
</tu>
<tu tuid="58">
<tuv xml:lang="en">
<seg>Unemployment benefit</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Allocation de chômage</seg>
</tuv>
</tu>
<tu tuid="59">
<tuv xml:lang="en">
<seg>time period:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>période:</seg>
</tuv>
</tu>
<tu tuid="60">
<tuv xml:lang="en">
<seg>Social assistance</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Aide sociale</seg>
</tuv>
</tu>
<tu tuid="61">
<tuv xml:lang="en">
<seg>time period:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>période:</seg>
</tuv>
</tu>
<tu tuid="62">
<tuv xml:lang="en">
<seg>Other benefit, state which</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Autre prestation, à préciser</seg>
</tuv>
</tu>
<tu tuid="63">
<tuv xml:lang="en">
<seg>time period:</seg>
</tuv>
<tuv xml:lang="fr">
<seg>période:</seg>
</tuv>
</tu>
<tu tuid="64">
<tuv xml:lang="en">
<seg>Datum</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date</seg>
</tuv>
</tu>
<tu tuid="65">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="66">
<tuv xml:lang="en">
<seg>Please send your reply to Försäkringskassan signed and dated at the latest by .</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Envoyez votre réponse, datée et signée, à Försäkringskassan au plus tard le .</seg>
</tuv>
</tu>
<tu tuid="67">
<tuv xml:lang="en">
<seg>Otherwise, Försäkringskassan will make a decision on the basis of the documentation available to us today.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Faute d’avoir de vos nouvelles, Försäkringskassan basera sa décision sur les éléments dont nous disposons aujourd’hui.</seg>
</tuv>
</tu>
<tu tuid="68">
<tuv xml:lang="en">
<seg>Do you have any questions?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Si vous avez des questions à poser</seg>
</tuv>
</tu>
<tu tuid="69">
<tuv xml:lang="en">
<seg>You are welcome to call our customer centre at +46 771-524 524 if you have any questions about your case.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous pouvez téléphoner à notre Service clientèle au +46 771-524 524, si vous avez des questions à poser concernant votre affaire.</seg>
</tuv>
</tu>
<tu tuid="70">
<tuv xml:lang="en">
<seg>Yours sincerely</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Sincères salutations</seg>
</tuv>
</tu>
<tu tuid="71">
<tuv xml:lang="en">
<seg>Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="72">
<tuv xml:lang="en">
<seg>Jessica Selander</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jessica Selander</seg>
</tuv>
</tu>
<tu tuid="73">
<tuv xml:lang="en">
<seg>Application</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Demande</seg>
</tuv>
</tu>
<tu tuid="74">
<tuv xml:lang="en">
<seg>Sickness compensation</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Indemnité de maladie</seg>
</tuv>
</tu>
<tu tuid="75">
<tuv xml:lang="en">
<seg>1 (3)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>1 (3)</seg>
</tuv>
</tu>
<tu tuid="76">
<tuv xml:lang="en">
<seg>0771-524 524 www.forsakringskassan.se</seg>
</tuv>
<tuv xml:lang="fr">
<seg>0771-524 524 www.forsakringskassan.se</seg>
</tuv>
</tu>
<tu tuid="77">
<tuv xml:lang="en">
<seg>Personal ID no.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro personnel d'identité</seg>
</tuv>
</tu>
<tu tuid="78">
<tuv xml:lang="en">
<seg>Send this form to</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adressez le formulaire à</seg>
</tuv>
</tu>
<tu tuid="79">
<tuv xml:lang="en">
<seg>Försäkringskassans inläsningscentral 839 88 Östersund</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Försäkringskassans inläsningscentral 839 88 Östersund</seg>
</tuv>
</tu>
<tu tuid="80">
<tuv xml:lang="en">
<seg>Applicant</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Le demandeur</seg>
</tuv>
</tu>
<tu tuid="81">
<tuv xml:lang="en">
<seg>Name and surname</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Prénom et nom</seg>
</tuv>
</tu>
<tu tuid="82">
<tuv xml:lang="en">
<seg>Personal ID no. (12 digits)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro national d'identité (12 chiffres)</seg>
</tuv>
</tu>
<tu tuid="83">
<tuv xml:lang="en">
<seg>Postal address</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adresse postale</seg>
</tuv>
</tu>
<tu tuid="84">
<tuv xml:lang="en">
<seg>Postal code and city</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Code postal et localité</seg>
</tuv>
</tu>
<tu tuid="85">
<tuv xml:lang="en">
<seg>Application refers to</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Objet de la demande</seg>
</tuv>
</tu>
<tu tuid="86">
<tuv xml:lang="en">
<seg>I am applying for</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je souhaite percevoir un quart</seg>
</tuv>
</tu>
<tu tuid="87">
<tuv xml:lang="en">
<seg>1/4</seg>
</tuv>
<tuv xml:lang="fr">
<seg>une moitié</seg>
</tuv>
</tu>
<tu tuid="88">
<tuv xml:lang="en">
<seg>full</seg>
</tuv>
<tuv xml:lang="fr">
<seg>la totalité</seg>
</tuv>
</tu>
<tu tuid="89">
<tuv xml:lang="en">
<seg>Describe why you are unable to work</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Décrivez pourquoi vous ne pouvez pas travailler</seg>
</tuv>
</tu>
<tu tuid="90">
<tuv xml:lang="en">
<seg>Give a brief description of why you are unable to work.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Décrivez en quelques mots pourquoi vous ne pouvez pas travailler.</seg>
</tuv>
</tu>
<tu tuid="91">
<tuv xml:lang="en">
<seg>We need this information to prepare your case.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nous avons besoin de ce renseignement pour pouvoir traiter votre affaire.</seg>
</tuv>
</tu>
<tu tuid="92">
<tuv xml:lang="en">
<seg>I am providing information I wish to give this information in an appendix verbally to Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je fournis les renseignements Je veux fournir les renseignements oralement dans une annexe à l'Agence suédoise de la sécurité sociale</seg>
</tuv>
</tu>
<tu tuid="93">
<tuv xml:lang="en">
<seg>I have attached a doctor's certificate</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je joins un certificat médical</seg>
</tuv>
</tu>
<tu tuid="94">
<tuv xml:lang="en">
<seg>We need a doctor's certificate to consider your application.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nous avons besoin d'un certificat médical pour pouvoir prendre position sur votre demande.</seg>
</tuv>
</tu>
<tu tuid="95">
<tuv xml:lang="en">
<seg>and will send it at a later date</seg>
</tuv>
<tuv xml:lang="fr">
<seg>et je l'enverrai plus tard</seg>
</tuv>
</tu>
<tu tuid="96">
<tuv xml:lang="en">
<seg>(name of physician)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>(Nom du médecin)</seg>
</tuv>
</tu>
<tu tuid="97">
<tuv xml:lang="en">
<seg>Yes No.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Oui Non.</seg>
</tuv>
</tu>
<tu tuid="98">
<tuv xml:lang="en">
<seg>Please specify where you have lived</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Indiquez ci-dessous où vous avez habité (en Suède ou dans d'autres pays).</seg>
</tuv>
</tu>
<tu tuid="99">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="100">
<tuv xml:lang="en">
<seg>Until (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jusqu'à (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="101">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="102">
<tuv xml:lang="en">
<seg>Until (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jusqu'à (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="103">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="104">
<tuv xml:lang="en">
<seg>Until (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jusqu'à (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="105">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="106">
<tuv xml:lang="en">
<seg>I am a contractor</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je suis prestataire de services</seg>
</tuv>
</tu>
<tu tuid="107">
<tuv xml:lang="en">
<seg>I am self-employed</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je suis entrepreneur individuel</seg>
</tuv>
</tu>
<tu tuid="108">
<tuv xml:lang="en">
<seg>Are you unemployed?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Êtes-vous chômeur?</seg>
</tuv>
</tu>
<tu tuid="109">
<tuv xml:lang="en">
<seg>Yes</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Oui</seg>
</tuv>
</tu>
<tu tuid="110">
<tuv xml:lang="en">
<seg>No</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Non</seg>
</tuv>
</tu>
<tu tuid="111">
<tuv xml:lang="en">
<seg>Name of your employer, principal or company</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nom de votre employeur, de votre donneur d'ordre ou de votre entreprise</seg>
</tuv>
</tu>
<tu tuid="112">
<tuv xml:lang="en">
<seg>Have you claimed unemployment benefit in the past four months?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Appartenez-vous à une caisse d'assurance-chômage (a-kassa)?</seg>
</tuv>
</tu>
<tu tuid="113">
<tuv xml:lang="en">
<seg>Have you worked in a country other than Sweden?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Avez-vous travaillé dans un autre pays que la Suède?</seg>
</tuv>
</tu>
<tu tuid="114">
<tuv xml:lang="en">
<seg>No</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Non</seg>
</tuv>
</tu>
<tu tuid="115">
<tuv xml:lang="en">
<seg>Yes, I have worked in</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Oui, j'ai</seg>
</tuv>
</tu>
<tu tuid="116">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="117">
<tuv xml:lang="en">
<seg>As of (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>travaillé</seg>
</tuv>
</tu>
<tu tuid="118">
<tuv xml:lang="en">
<seg>Until (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>dans un</seg>
</tuv>
</tu>
<tu tuid="119">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="120">
<tuv xml:lang="en">
<seg>Until (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>autre pays</seg>
</tuv>
</tu>
<tu tuid="121">
<tuv xml:lang="en">
<seg>Do you receive compensation, or have you applied for compensation, from a country other than Sweden?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Percevez-vous une prestation ou avez-vous demandé une prestation dans un autre pays que la Suède?</seg>
</tuv>
</tu>
<tu tuid="122">
<tuv xml:lang="en">
<seg>No</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Non</seg>
</tuv>
</tu>
<tu tuid="123">
<tuv xml:lang="en">
<seg>Yes Sickness benefit Pension</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Oui Indemnité de maladie Retraite</seg>
</tuv>
</tu>
<tu tuid="124">
<tuv xml:lang="en">
<seg>Perpetual annuity or pension due to occupational injury</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Rente d'invalidité ou une pension en raison d'un accident de travail</seg>
</tuv>
</tu>
<tu tuid="125">
<tuv xml:lang="en">
<seg>Name and address of the paying authority</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nom et adresse de l'autorité qui effectue le versement</seg>
</tuv>
</tu>
<tu tuid="126">
<tuv xml:lang="en">
<seg>Will you have any other income than the potential sickness compensation, such as a salary or an occupational pension?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Aurez-vous un autre revenu qu'une éventuelle indemnité de maladie, par exemple salaire ou retraite?</seg>
</tuv>
</tu>
<tu tuid="127">
<tuv xml:lang="en">
<seg>No Yes, fill in below</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Non Oui, je l'indique ci-dessous</seg>
</tuv>
</tu>
<tu tuid="128">
<tuv xml:lang="en">
<seg>We need to know if you have any other income in order to determine who is entitled to deduct tax according to tax tables.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nous avons besoin de savoir si vous avez un autre revenu pour pouvoir décider qui devra percevoir l'impôt d'après le barème d'imposition.</seg>
</tuv>
</tu>
<tu tuid="129">
<tuv xml:lang="en">
<seg>Payer</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Payeur</seg>
</tuv>
</tu>
<tu tuid="130">
<tuv xml:lang="en">
<seg>SEK per month</seg>
</tuv>
<tuv xml:lang="fr">
<seg>SEK par mois</seg>
</tuv>
</tu>
<tu tuid="131">
<tuv xml:lang="en">
<seg>Payer</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Payeur</seg>
</tuv>
</tu>
<tu tuid="132">
<tuv xml:lang="en">
<seg>Account number</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro de compte PlusGiro</seg>
</tuv>
</tu>
<tu tuid="133">
<tuv xml:lang="en">
<seg>PlusGiro account</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Compte bancaire</seg>
</tuv>
</tu>
<tu tuid="134">
<tuv xml:lang="en">
<seg>Personal ID no.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro de compte</seg>
</tuv>
</tu>
<tu tuid="135">
<tuv xml:lang="en">
<seg>Complete this section if you want to grant another person power of attorney to handle all matters on your behalf.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous ne devez remplir ce point que si vous voulez donner à quelqu'un d'autre un pouvoir pour vous représenter.</seg>
</tuv>
</tu>
<tu tuid="136">
<tuv xml:lang="en">
<seg>The person you appoint will receive correspondence and get access to all documentation relating to your case.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Autrement, vous devez aller aux points suivants du formulaire.</seg>
</tuv>
</tu>
<tu tuid="137">
<tuv xml:lang="en">
<seg>The power of attorney is valid until a final decision is rendered in this matter.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Le pouvoir est valable jusqu'à ce que je l'annule.</seg>
</tuv>
</tu>
<tu tuid="138">
<tuv xml:lang="en">
<seg>Personal ID no. (12 digits)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro national d'identité (renseignement facultatif)</seg>
</tuv>
</tu>
<tu tuid="139">
<tuv xml:lang="en">
<seg>Telephone, evening, including area code</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Téléphone au domicile, y compris indicatif</seg>
</tuv>
</tu>
<tu tuid="140">
<tuv xml:lang="en">
<seg>Additional information (optional)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Renseignements divers</seg>
</tuv>
</tu>
<tu tuid="141">
<tuv xml:lang="en">
<seg>Additional information provided separately</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je fournis des renseignements dans une annexe</seg>
</tuv>
</tu>
<tu tuid="142">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="143">
<tuv xml:lang="en">
<seg>I solemnly declare that the information provided in this form is correct and complete.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je certifie sur l'honneur que les renseignements fournis dans le formulaire sont exacts et complets.</seg>
</tuv>
</tu>
<tu tuid="144">
<tuv xml:lang="en">
<seg>Should this information change, I am obliged to inform Försäkringskassan.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Lorsque ces renseignements changeront, je dois le communiquer à l'Agence suédoise de la sécurité sociale.</seg>
</tuv>
</tu>
<tu tuid="145">
<tuv xml:lang="en">
<seg>I am aware that it is a punishable offense to provide false information, omit information or to not notify Försäkringskassan if any of the information I have provided should change.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je sais qu'il est punissable par la loi de fournir des renseignements inexacts, de dissimuler quelque chose ou de ne pas indiquer à l'Agence suédoise de la sécurité sociale les changements survenus dans les renseignements que j'ai fournis.</seg>
</tuv>
</tu>
<tu tuid="146">
<tuv xml:lang="en">
<seg>Telephone, daytime, including area code</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Téléphone au lieu de travail, y compris indicatif</seg>
</tuv>
</tu>
<tu tuid="147">
<tuv xml:lang="en">
<seg>Telephone, evening, including area code</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Téléphone au domicile, y compris indicatif</seg>
</tuv>
</tu>
<tu tuid="148">
<tuv xml:lang="en">
<seg>Date</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date</seg>
</tuv>
</tu>
<tu tuid="149">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="150">
<tuv xml:lang="en">
<seg>Complete this section if you are signing on behalf of the applicant as a trustee or administrator Please enclose with this document a register extract showing that you have been appointed as a trustee or administrator.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Remplissez la partie ci-dessous si vous signez en tant que tuteur ou curateur de la personne qui fait la demande</seg>
</tuv>
</tu>
<tu tuid="151">
<tuv xml:lang="en">
<seg>The information provided above is held in the database of the Swedish Social Insurance Agency.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Ces renseignements sont traités dans le système informatique de l'Agence suédoise de la sécurité sociale.</seg>
</tuv>
</tu>
<tu tuid="152">
<tuv xml:lang="en">
<seg>Once we are in receipt of your application, you will be contacted by one of our administrators.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Un conseiller vous contactera dans un délai d'une semaine après que votre demande nous soit parvenue.</seg>
</tuv>
</tu>
<tu tuid="153">
<tuv xml:lang="en">
<seg>You will then together go through your application and you will be advised of how long you can expect to wait for a decision in the matter.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Il ou elle vous aidera à compléter éventuellement votre demande et vous pourrez savoir dans quel délai vous recevrez la décision.</seg>
</tuv>
</tu>
<tu tuid="154">
<tuv xml:lang="en">
<seg>You may be entitled to housing supplement</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous pouvez avoir droit à une allocation logement complémentaire</seg>
</tuv>
</tu>
<tu tuid="155">
<tuv xml:lang="en">
<seg>If you are receiving sickness compensation and live in Sweden, you may also be entitled to housing supplement.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Si vous percevez une indemnité d'activité et que vous habitez en Suède, vous pouvez éventuellement vous voir accorder une allocation-logement complémentaire.</seg>
</tuv>
</tu>
<tu tuid="156">
<tuv xml:lang="en">
<seg>For more information and to download the relevant application form, visit www.forsakringskassan.se.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Téléchargez un formulaire de demande et lisez les informations sur forsakringskassan.se.</seg>
</tuv>
</tu>
<tu tuid="157">
<tuv xml:lang="en">
<seg>Application</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Demande</seg>
</tuv>
</tu>
<tu tuid="158">
<tuv xml:lang="en">
<seg>Activity compensation for</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Indemnité d'activité en cas de</seg>
</tuv>
</tu>
<tu tuid="159">
<tuv xml:lang="en">
<seg>1 (3)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>1 (3)</seg>
</tuv>
</tu>
<tu tuid="160">
<tuv xml:lang="en">
<seg>0771-524 524 www.forsakringskassan.se</seg>
</tuv>
<tuv xml:lang="fr">
<seg>0771-524 524 www.forsakringskassan.se</seg>
</tuv>
</tu>
<tu tuid="161">
<tuv xml:lang="en">
<seg>impaired working ability</seg>
</tuv>
<tuv xml:lang="fr">
<seg>capacité de travail réduite</seg>
</tuv>
</tu>
<tu tuid="162">
<tuv xml:lang="en">
<seg>Personal ID no.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro personnel d'identité</seg>
</tuv>
</tu>
<tu tuid="163">
<tuv xml:lang="en">
<seg>Send this form to</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adressez le formulaire à</seg>
</tuv>
</tu>
<tu tuid="164">
<tuv xml:lang="en">
<seg>Försäkringskassans inläsningscentral 839 88 Östersund</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Försäkringskassans inläsningscentral 839 88 Östersund</seg>
</tuv>
</tu>
<tu tuid="165">
<tuv xml:lang="en">
<seg>Applicant</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Le demandeur</seg>
</tuv>
</tu>
<tu tuid="166">
<tuv xml:lang="en">
<seg>Name and surname</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Prénom et nom</seg>
</tuv>
</tu>
<tu tuid="167">
<tuv xml:lang="en">
<seg>Personal ID no. (12 digits)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro national d'identité (12 chiffres)</seg>
</tuv>
</tu>
<tu tuid="168">
<tuv xml:lang="en">
<seg>Postal address</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adresse postale</seg>
</tuv>
</tu>
<tu tuid="169">
<tuv xml:lang="en">
<seg>Postal code and city</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Code postal et localité</seg>
</tuv>
</tu>
<tu tuid="170">
<tuv xml:lang="en">
<seg>Application refers to</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Objet de la demande</seg>
</tuv>
</tu>
<tu tuid="171">
<tuv xml:lang="en">
<seg>I am applying for</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je souhaite percevoir un quart</seg>
</tuv>
</tu>
<tu tuid="172">
<tuv xml:lang="en">
<seg>1/4</seg>
</tuv>
<tuv xml:lang="fr">
<seg>une moitié</seg>
</tuv>
</tu>
<tu tuid="173">
<tuv xml:lang="en">
<seg>As of year, month</seg>
</tuv>
<tuv xml:lang="fr">
<seg>À partir de année, mois</seg>
</tuv>
</tu>
<tu tuid="174">
<tuv xml:lang="en">
<seg>Describe why you are unable to work</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Décrivez pourquoi vous ne pouvez pas travailler</seg>
</tuv>
</tu>
<tu tuid="175">
<tuv xml:lang="en">
<seg>Give a brief description of why you are unable to work.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Décrivez en quelques mots pourquoi vous ne pouvez pas travailler.</seg>
</tuv>
</tu>
<tu tuid="176">
<tuv xml:lang="en">
<seg>We need this information to prepare your case.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nous avons besoin de ce renseignement pour pouvoir traiter votre affaire.</seg>
</tuv>
</tu>
<tu tuid="177">
<tuv xml:lang="en">
<seg>I am providing information I wish to give this information in an appendix verbally to Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je fournis les renseignements Je veux fournir les renseignements oralement dans une annexe. à l'Agence suédoise de la sécurité sociale.</seg>
</tuv>
</tu>
<tu tuid="178">
<tuv xml:lang="en">
<seg>I have attached a doctor's certificate</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je joins un certificat médical.</seg>
</tuv>
</tu>
<tu tuid="179">
<tuv xml:lang="en">
<seg>We need a doctor's certificate to consider your application.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nous avons besoin d'un certificat médical pour pouvoir prendre position sur votre demande.</seg>
</tuv>
</tu>
<tu tuid="180">
<tuv xml:lang="en">
<seg>and will submit it later on</seg>
</tuv>
<tuv xml:lang="fr">
<seg>et je l'enverrai plus tard</seg>
</tuv>
</tu>
<tu tuid="181">
<tuv xml:lang="en">
<seg>(name of physician)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>(Nom du médecin)</seg>
</tuv>
</tu>
<tu tuid="182">
<tuv xml:lang="en">
<seg>Yes No.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Oui Non.</seg>
</tuv>
</tu>
<tu tuid="183">
<tuv xml:lang="en">
<seg>Please specify where you have lived</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Indiquez ci-dessous où vous avez habité</seg>
</tuv>
</tu>
<tu tuid="184">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="185">
<tuv xml:lang="en">
<seg>As of (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Depuis (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="186">
<tuv xml:lang="en">
<seg>Until (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jusqu'à (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="187">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="188">
<tuv xml:lang="en">
<seg>As of (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Depuis (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="189">
<tuv xml:lang="en">
<seg>No Yes</seg>
</tuv>
<tuv xml:lang="fr">
<seg>No Oui</seg>
</tuv>
</tu>
<tu tuid="190">
<tuv xml:lang="en">
<seg>Personal ID no.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Oui, j'ai</seg>
</tuv>
</tu>
<tu tuid="191">
<tuv xml:lang="en">
<seg>2 (3)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="192">
<tuv xml:lang="en">
<seg>No</seg>
</tuv>
<tuv xml:lang="fr">
<seg>travaillé</seg>
</tuv>
</tu>
<tu tuid="193">
<tuv xml:lang="en">
<seg>Yes, I have worked in</seg>
</tuv>
<tuv xml:lang="fr">
<seg>dans un</seg>
</tuv>
</tu>
<tu tuid="194">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pays</seg>
</tuv>
</tu>
<tu tuid="195">
<tuv xml:lang="en">
<seg>As of (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Depuis (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="196">
<tuv xml:lang="en">
<seg>Until (year, month, day)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Jusqu'à (année, mois, jour)</seg>
</tuv>
</tu>
<tu tuid="197">
<tuv xml:lang="en">
<seg>Country</seg>
</tuv>
<tuv xml:lang="fr">
<seg>autre pays</seg>
</tuv>
</tu>
<tu tuid="198">
<tuv xml:lang="en">
<seg>Do you receive compensation, or have you applied for compensation, from a country other than Sweden?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Percevez-vous une prestation ou avez-vous demandé une prestation dans un autre pays que la Suède?</seg>
</tuv>
</tu>
<tu tuid="199">
<tuv xml:lang="en">
<seg>No</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Non</seg>
</tuv>
</tu>
<tu tuid="200">
<tuv xml:lang="en">
<seg>Yes Sickness benefit Pension</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Oui Indemnité de maladie Retraite</seg>
</tuv>
</tu>
<tu tuid="201">
<tuv xml:lang="en">
<seg>Perpetual annuity or pension due to occupational injury</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Rente d'invalidité ou une pension en raison d'un accident de travail</seg>
</tuv>
</tu>
<tu tuid="202">
<tuv xml:lang="en">
<seg>Name and address of the paying authority</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nom et adresse de l'autorité qui effectue le versement</seg>
</tuv>
</tu>
<tu tuid="203">
<tuv xml:lang="en">
<seg>Will you have any other income than the potential sickness compensation, such as a salary or an occupational pension?</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Aurez-vous un autre revenu qu'une éventuelle indemnité de maladie, par exemple salaire ou retraite?</seg>
</tuv>
</tu>
<tu tuid="204">
<tuv xml:lang="en">
<seg>No Yes, fill in below</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Non Oui, je l'indique ci-dessous</seg>
</tuv>
</tu>
<tu tuid="205">
<tuv xml:lang="en">
<seg>We need to know if you have any other income in order to determine who is entitled to deduct tax according to tax tables.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nous avons besoin de savoir si vous avez un autre revenu pour pouvoir décider qui devra percevoir l'impôt d'après le barème d'imposition.</seg>
</tuv>
</tu>
<tu tuid="206">
<tuv xml:lang="en">
<seg>Payer</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Payeur</seg>
</tuv>
</tu>
<tu tuid="207">
<tuv xml:lang="en">
<seg>SEK per month</seg>
</tuv>
<tuv xml:lang="fr">
<seg>SEK par mois</seg>
</tuv>
</tu>
<tu tuid="208">
<tuv xml:lang="en">
<seg>Payer</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Payeur</seg>
</tuv>
</tu>
<tu tuid="209">
<tuv xml:lang="en">
<seg>Account number</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro de compte PlusGiro</seg>
</tuv>
</tu>
<tu tuid="210">
<tuv xml:lang="en">
<seg>PlusGiro account</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Compte bancaire</seg>
</tuv>
</tu>
<tu tuid="211">
<tuv xml:lang="en">
<seg>Personal ID no.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro de compte</seg>
</tuv>
</tu>
<tu tuid="212">
<tuv xml:lang="en">
<seg>Complete this section if you want to grant another person power of attorney to handle all matters on your behalf.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous ne devez remplir ce point que si vous voulez donner à quelqu'un d'autre un pouvoir pour vous représenter.</seg>
</tuv>
</tu>
<tu tuid="213">
<tuv xml:lang="en">
<seg>The person you appoint will receive correspondence and get access to all documentation relating to your case.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Autrement, vous devez aller aux points suivants du formulaire.</seg>
</tuv>
</tu>
<tu tuid="214">
<tuv xml:lang="en">
<seg>The power of attorney is valid until a final decision is rendered in this matter.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Le pouvoir est valable jusqu'à ce que je l'annule.</seg>
</tuv>
</tu>
<tu tuid="215">
<tuv xml:lang="en">
<seg>Personal ID no. (12 digits)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Numéro national d'identité (renseignement facultatif)</seg>
</tuv>
</tu>
<tu tuid="216">
<tuv xml:lang="en">
<seg>Telephone, evening, including area code</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Téléphone au domicile, y compris indicatif</seg>
</tuv>
</tu>
<tu tuid="217">
<tuv xml:lang="en">
<seg>Additional information (optional)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Renseignements divers</seg>
</tuv>
</tu>
<tu tuid="218">
<tuv xml:lang="en">
<seg>Additional information provided separately</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je fournis des renseignements dans une annexe</seg>
</tuv>
</tu>
<tu tuid="219">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="220">
<tuv xml:lang="en">
<seg>I solemnly declare that the information provided in this form is correct and complete.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je certifie sur l'honneur que les renseignements fournis dans le formulaire sont exacts et complets.</seg>
</tuv>
</tu>
<tu tuid="221">
<tuv xml:lang="en">
<seg>Should this information change, I am obliged to inform Försäkringskassan.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Lorsque ces renseignements changeront, je dois en informer l'Agence suédoise de la sécurité sociale.</seg>
</tuv>
</tu>
<tu tuid="222">
<tuv xml:lang="en">
<seg>I am aware that it is a punishable offense to provide false information, omit information or to not notify Försäkringskassan if any of the information I have provided should change.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Je sais qu'il est répréhensible de fournir des informations erronées, d'omettre des éléments ou de ne pas informer l'Agence suédoise de la sécurité sociale lorsque les informations que j'ai communiquées changent.</seg>
</tuv>
</tu>
<tu tuid="223">
<tuv xml:lang="en">
<seg>Date</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date</seg>
</tuv>
</tu>
<tu tuid="224">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="225">
<tuv xml:lang="en">
<seg>Complete this section if you are signing on behalf of the applicant as a trustee or administrator Please enclose with this document a register extract showing that you have been appointed as a trustee or administrator.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Remplissez la partie ci-dessous si vous signez en tant que tuteur ou curateur de la personne qui fait la demande</seg>
</tuv>
</tu>
<tu tuid="226">
<tuv xml:lang="en">
<seg>The information provided above is held in the database of the Swedish Social Insurance Agency.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Ces renseignements sont traités dans le système informatique de l'Agence suédoise de la sécurité sociale.</seg>
</tuv>
</tu>
<tu tuid="227">
<tuv xml:lang="en">
<seg>Once we are in receipt of your application, you will be contacted by one of our administrators.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Un conseiller vous contactera dans un délai d'une semaine après que votre demande nous soit parvenue.</seg>
</tuv>
</tu>
<tu tuid="228">
<tuv xml:lang="en">
<seg>You will then together go through your application and you will be advised of how long you can expect to wait for a decision in the matter.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Il ou elle vous aidera à compléter éventuellement votre demande et vous pourrez savoir dans quel délai vous recevrez la décision.</seg>
</tuv>
</tu>
<tu tuid="229">
<tuv xml:lang="en">
<seg>You may be entitled to housing supplement</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Vous pouvez avoir droit à une allocation logement complémentaire</seg>
</tuv>
</tu>
<tu tuid="230">
<tuv xml:lang="en">
<seg>If you are receiving activity compensation and live in Sweden, you may also be entitled to housing supplement.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Si vous percevez une indemnité d'activité et que vous habitez en Suède, vous pouvez éventuellement vous voir accorder une allocation-logement complémentaire.</seg>
</tuv>
</tu>
<tu tuid="231">
<tuv xml:lang="en">
<seg>For more information and to download the relevant application form, visit www.forsakringskassan.se.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Téléchargez un formulaire de demande et lisez les informations sur forsakringskassan.se.</seg>
</tuv>
</tu>
<tu tuid="232">
<tuv xml:lang="en">
<seg>Agreement on child support</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Accord sur la pension alimentaire pour un(e) enfant</seg>
</tuv>
</tu>
<tu tuid="233">
<tuv xml:lang="en">
<seg>1 (1)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>1 (1)</seg>
</tuv>
</tu>
<tu tuid="234">
<tuv xml:lang="en">
<seg>Child who is to receive child support</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Enfant qui bénéficiera de la pension alimentaire</seg>
</tuv>
</tu>
<tu tuid="235">
<tuv xml:lang="en">
<seg>Forname(s) and Surname Child's personal ID no.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Prénom et nom</seg>
</tuv>
</tu>
<tu tuid="236">
<tuv xml:lang="en">
<seg>Parent with whom the child lives</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Parent avec qui l'enfant vit</seg>
</tuv>
</tu>
<tu tuid="237">
<tuv xml:lang="en">
<seg>Forname(s) and Surname</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Prénom et nom</seg>
</tuv>
</tu>
<tu tuid="238">
<tuv xml:lang="en">
<seg>Parent who is to pay child support (child support debtor)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Parent qui versera la pension alimentaire</seg>
</tuv>
</tu>
<tu tuid="239">
<tuv xml:lang="en">
<seg>Forname(s) and Surname</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Prénom et nom</seg>
</tuv>
</tu>
<tu tuid="240">
<tuv xml:lang="en">
<seg>Child support which is to be paid to the child</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pension alimentaire à verser pour l'enfant</seg>
</tuv>
</tu>
<tu tuid="241">
<tuv xml:lang="en">
<seg>Starting date of payment of child support</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La pension alimentaire sera versée à compter du</seg>
</tuv>
</tu>
<tu tuid="242">
<tuv xml:lang="en">
<seg>Child support is to be paid until the child attains the age of 18</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La pension alimentaire sera payée jusqu'à ce que l'enfant atteigne l'âge de 18 ans, date</seg>
</tuv>
</tu>
<tu tuid="243">
<tuv xml:lang="en">
<seg>Other date</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Autre date</seg>
</tuv>
</tu>
<tu tuid="244">
<tuv xml:lang="en">
<seg>Amount to be paid, Swedish kronor (SEK) per month (in words)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Montant à payer, couronnes suédoises par mois en toute lettres</seg>
</tuv>
</tu>
<tu tuid="245">
<tuv xml:lang="en">
<seg>Amount in figures, SEK</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Montant en chiffres, couronnes suédoises</seg>
</tuv>
</tu>
<tu tuid="246">
<tuv xml:lang="en">
<seg>Provisions on payment</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Dispositions relatives au paiement</seg>
</tuv>
</tu>
<tu tuid="247">
<tuv xml:lang="en">
<seg>Child support for the coming month falls due for payment on the last day of the previous month according to Chapter 7, section 7, of the Children and Parents Code.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La pension alimentaire arrive à échéance le dernier jour du mois et se rapporte au mois suivant, conformément au chap. 7, art. 7 du Code suédois de la filiation et de la minorité.</seg>
</tuv>
</tu>
<tu tuid="248">
<tuv xml:lang="en">
<seg>According to the Swedish Ordinance (1966:680) on Changes to Certain Child Support Amounts, the amount will be annually adjusted to the cost of living.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Conformément à la loi (1966:680) sur la modification de certaines pensions alimentaires, le montant est révisé chaque année compte tenu des changements de la valeur monétaire.</seg>
</tuv>
</tu>
<tu tuid="249">
<tuv xml:lang="en">
<seg>Any increases will apply from 1 February.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Tout relèvement éventuel prend effet le 1er février.</seg>
</tuv>
</tu>
<tu tuid="250">
<tuv xml:lang="en">
<seg>Signature of the child support debtor</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature du parent qui versera la pension alimentaire</seg>
</tuv>
</tu>
<tu tuid="251">
<tuv xml:lang="en">
<seg>Date of signature of agreement Parent's signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date de la signature de l'accord Signature du parent</seg>
</tuv>
</tu>
<tu tuid="252">
<tuv xml:lang="en">
<seg>The parent's signature witnessed by two persons</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La signature du parent est certifiée authentique par deux personnes</seg>
</tuv>
</tu>
<tu tuid="253">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="254">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="255">
<tuv xml:lang="en">
<seg>Name in block letters</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nom en caractères moulés</seg>
</tuv>
</tu>
<tu tuid="256">
<tuv xml:lang="en">
<seg>Name in block letters</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nom en caractères moulés</seg>
</tuv>
</tu>
<tu tuid="257">
<tuv xml:lang="en">
<seg>Address</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adresse</seg>
</tuv>
</tu>
<tu tuid="258">
<tuv xml:lang="en">
<seg>Address</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adresse</seg>
</tuv>
</tu>
<tu tuid="259">
<tuv xml:lang="en">
<seg>Approval, on behalf of the child, by the parent with whom the child lives</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Le parent avec qui l'enfant vit accepte l'accord pour le compte de l'enfant</seg>
</tuv>
</tu>
<tu tuid="260">
<tuv xml:lang="en">
<seg>FK 5251en (003 F 002) Fastställd av Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>FK 5251fr (002 F 002) Fastställd av Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="261">
<tuv xml:lang="en">
<seg>FK 5251en (003 F 002) Fastställd av Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>FK 5251fr (002 F 002) Fastställd av Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="262">
<tuv xml:lang="en">
<seg>Date Parent's signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date Signature du parent</seg>
</tuv>
</tu>
<tu tuid="263">
<tuv xml:lang="en">
<seg>Agreement on child support</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Accord sur la pension alimentaire pour un(e) enfant</seg>
</tuv>
</tu>
<tu tuid="264">
<tuv xml:lang="en">
<seg>1 (1)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>1 (1)</seg>
</tuv>
</tu>
<tu tuid="265">
<tuv xml:lang="en">
<seg>Forname(s) and Surname</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Prénom et nom</seg>
</tuv>
</tu>
<tu tuid="266">
<tuv xml:lang="en">
<seg>Parent who is to pay child support (child support debtor)</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Parent qui versera la pension alimentaire</seg>
</tuv>
</tu>
<tu tuid="267">
<tuv xml:lang="en">
<seg>Forname(s) and Surname Parent's personal ID no.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Prénom et nom</seg>
</tuv>
</tu>
<tu tuid="268">
<tuv xml:lang="en">
<seg>Child support which is to be paid</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Pension alimentaire à verser</seg>
</tuv>
</tu>
<tu tuid="269">
<tuv xml:lang="en">
<seg>Starting date of payment of child support</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La pension alimentaire sera versée à compter du</seg>
</tuv>
</tu>
<tu tuid="270">
<tuv xml:lang="en">
<seg>Child support is to be paid during the period of study, which is expected to continue until</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La pension alimentaire sera payée pendant la durée des études, qui, selon les estimations, se poursuivront jusqu'au</seg>
</tuv>
</tu>
<tu tuid="271">
<tuv xml:lang="en">
<seg>Provisions on payment</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Dispositions relatives au paiement</seg>
</tuv>
</tu>
<tu tuid="272">
<tuv xml:lang="en">
<seg>Child support for the coming month falls due for payment on the last day of the previous month according to Chapter 7, section 7, of the Children and Parents Code.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La pension alimentaire arrive à échéance le dernier jour du mois et se rapporte au mois suivant, conformément au chap. 7, art. 7 du Code suédois de la filiation et de la minorité.</seg>
</tuv>
</tu>
<tu tuid="273">
<tuv xml:lang="en">
<seg>According to the Swedish Ordinance (1966:680) on Changes to Certain Child Support Amounts, the amount will be annually adjusted to the cost of living.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Conformément à la loi (1966:680) sur la modification de certaines pensions alimentaires, le montant est révisé chaque année compte tenu des changements de la valeur monétaire.</seg>
</tuv>
</tu>
<tu tuid="274">
<tuv xml:lang="en">
<seg>Any increases will apply from 1 February.</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Tout relèvement éventuel prend effet le 1er février.</seg>
</tuv>
</tu>
<tu tuid="275">
<tuv xml:lang="en">
<seg>Signature of the child support debtor</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature du parent qui versera la pension alimentaire</seg>
</tuv>
</tu>
<tu tuid="276">
<tuv xml:lang="en">
<seg>Date of signature of agreement Parent's signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date de la signature de l'accord Signature du parent</seg>
</tuv>
</tu>
<tu tuid="277">
<tuv xml:lang="en">
<seg>The parent's signature witnessed by two persons</seg>
</tuv>
<tuv xml:lang="fr">
<seg>La signature du parent est certifiée authentique par deux personnes</seg>
</tuv>
</tu>
<tu tuid="278">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="279">
<tuv xml:lang="en">
<seg>Signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Signature</seg>
</tuv>
</tu>
<tu tuid="280">
<tuv xml:lang="en">
<seg>Name in block letters</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nom en caractères moulés</seg>
</tuv>
</tu>
<tu tuid="281">
<tuv xml:lang="en">
<seg>Name in block letters</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Nom en caractères moulés</seg>
</tuv>
</tu>
<tu tuid="282">
<tuv xml:lang="en">
<seg>Address</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adresse</seg>
</tuv>
</tu>
<tu tuid="283">
<tuv xml:lang="en">
<seg>Address</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Adresse</seg>
</tuv>
</tu>
<tu tuid="284">
<tuv xml:lang="en">
<seg>Approval of the agreement by the school student</seg>
</tuv>
<tuv xml:lang="fr">
<seg>L'étudiant accepte l'accord pour son compte personnel</seg>
</tuv>
</tu>
<tu tuid="285">
<tuv xml:lang="en">
<seg>FK 5252en (003 F 003) Fastställd av Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>FK 5252fr (002 F 002) Fastställd av Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="286">
<tuv xml:lang="en">
<seg>FK 5252en (003 F 003) Fastställd av Försäkringskassan</seg>
</tuv>
<tuv xml:lang="fr">
<seg>FK 5252fr (002 F 002) Fastställd av Försäkringskassan</seg>
</tuv>
</tu>
<tu tuid="287">
<tuv xml:lang="en">
<seg>Date School student's signature</seg>
</tuv>
<tuv xml:lang="fr">
<seg>Date Signature de l'étudiant</seg>
</tuv>
</tu>
</body>
</tmx>
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