| E-FORM |
Description |
| E103 |
Exercising the right of option |
| E104 |
Certificate concerning the aggregation of periods of insurance,
employment or residence. Allow you to be covered by the social security
in your new country. |
| E105 |
Certificate concerning the members of the family of an
employed person or self-employed person to be taken into consideration for
the calculation of cash benefits in the case of incapacity for work |
| E106 |
Certificate of entitlement to sickness and maternity insurance
benefits in kind for persons residing in a country other than the competent
country. Used by people going to work in another country. |
| E107 |
Application for a certificate of entitlement to benefits
in kind |
| E108 |
Notification of suspension or withdrawal of the right
to sickness and maternity insurance benefits in kind |
| E109 |
Certificate for the registration of members of the employed
or self-employed person's family and the updating of lists. For example
if the person works in country A and his/her family go to country B within
the EU, they will be entitle to medical protection in country B. |
| E110 |
Certificate concerning employed persons in international
transport. It is replaced by the European Health Insurance
Card. |
| E111 |
Certificate of entitlement to benefits in kind during
a stay in a Member State. This is the most commonly used E Form. It is used
by insured people going to another country for a short period, whether for
a holiday or for a short business trip, and covers emergency treatment only.
It is replaced by the European Health Insurance Card.
|
| E111B |
For hospitalisation only - Certificate of entitlement
to benefits in kind during a stay in a Member State -Scheme for self-employed
persons |
| E112 |
Certificate concerning the retention of the right to sickness
or maternity benefits currently being provided |
| E113 |
Hospitalisation: notification of entering and leaving
hospital |
| E114 |
Granting of major benefits in kind |
| E115 |
Claim for cash benefits for incapacity for work |
| E116 |
Medical report relating to incapacity for work (sickness,
maternity, accident at work, occupational disease) |
| E117 |
Granting of cash benefits in the case of maternity and
incapacity for work |
| E118 |
Notification of non-recognition or of end of incapacity
for work |
| E118 Annex |
Legal remedies and periods allowed for appeals |
| E119 |
Certificate concerning the entitlement of unemployed persons
and the members of their family to sickness and maternity insurance benefits.
It is replaced by the European Health Insurance Card.
In addition, if you get unemployment benefits, it will allow you to benefit
from the social security back in your country |
| E120 |
Certificate of entitlement to benefits in kind for pension
claimants and members of their family |
| E121 |
Certificate for the registration of pensioners and the
updating of lists |
| E122 |
Certificate for the granting of benefits in kind to members
of the family of pensioners. For example if the person gewts a pension in
country A and his/her family go to country B within the EU, they will be
entitle to medical protection in country B. |
| E123 |
Certificate of entitlement to benefits in kind under insurance
against accidents at work and occupational diseases |
| E124 |
Claim for death grant |
| E124 additional |
Additional information for the purposes of Portuguese
institutions |
| E125 |
Individual record of actual expenditure |
| E125A additional |
Additional information for the purposes of Norwegian institutions
|
| E126 |
Rates for refund of benefits in kind |
| E127 |
Individual record of monthly lump-sum payments |
| E128 |
Certificate of entitlement to necessary benefits in kind
during a stay in a Member State. Covers health care for workers whose social
insurance contributions are paid in their country of residence while they
work in another country for up to a year. It is replaced
by the European Health Insurance Card. |
| E128B |
Certificate of entitlement to necessary benefits in kind
during a stay in a Member State : for hospitalisation only - scheme for
self-employed persons |
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