AUSGLEICHSKASSE UG“ WHASTELLE 2UG Application for family allowances AH vj IV (employees in the agricultural sector excluded) A | Identity of the applicant | | erfemale x male 7 Sumame(s) SECERE First name(@)__ GEORGE — BOG SAV adios: SHA Auier uh 22 BUAG to 2p ZIP / city elias Nationality: RONAN TART _ E-mail 224 Insurance no: IL JETT TILL Phone: Date of bith: 2. O. Civil status: single (A married / registered chil partnership since: MAY 2002 | O widowed singe: | O factually separated since: | Olegally separated since: | os Beene sce | Identity of the applicant's children (up until 25 years of age) Aston ‘Surname(s): SECERE own child 0 foster child First name(sy__ VEAK — JOU 'T. 1 adopted child grandchild NERS — Jou Dateofbit 0403. 2011 spouses child sbiogs Adres: Lng 32 coun, ROMAN? A 7 Fr Income during apprenticeship or ongoing education | | i | 02 | ea ‘Surmame(s): Clown child foster child | First name(s): adopted child 0 grandchild Date of birth: J spouse's child 0 siblings Address: Country: Income during apprenticeship or ongoing education Fr, | (oss slay, yt on aes, day cash benef and pensions) [Fr tarterchisren please use the supplemertary shoot 1 to this application must also bo approved by the (04 | authority of your residential municipality C Additional information | Date as of when you are claiming family allowances? ‘Who has been receiving family allowances so far? unt | Are you already receiving any family allowances for one or more of the listed children? no Byes | iif ‘80, from whom? | For which cild? What amount? Name: Fr | Name: Fr. | Which office pays the allowances? 05 | Do you have more than one employer? CI no Clyes so, peese iin the supplementary shoot 2) ‘Ausgleichskasse Zug | Baarersiesse 11, Postfach 4092, 6204 Zug « Telefon 041 560 47 00, Telefe O21 560.47 47 W.Stalle Zug | Ofinungszeltn: Montag — Fret 8.3017 Uhr « wwiv.akaug.ch» infe@akzug.chD | Identity of the applicant's spouse or registered partner in ld ‘Surmame(s) RE = First name(s): RUXAWALA i Insurance no [ [TILL] ate orbit: 0%. 0. TLS | ‘Are you employed? 21 no yes Employer: | | Employed since: | Address. § CPROYA St Retuer wp 2 | | ofultime Sw workload Place of work: | Do you have more than one employer? CI no yes —_Hs0, please fil inthe supplementary sheet 2), (06. | Who eams a higher salary (gross)? Spouse / partner JM Applicant (A) I Parent ving in 2 separate household | ‘Surname(s) First name(s) | Address: ZIP / city: Insurance no} LL [LT] bate of bith il status Since: ‘Ne youenpioyet? 6) ne Employer, | Emoojedsree | pats: ‘fulltime % workload Place of work | 07, | Do you have more than one employer? Ono Dyes so, plate nthe euplamentary sheet 2) | F | Confirmation from the applicant's employer | Company: ‘Account no. [ i Address: Contact | | ZIP / city Phone: { || Employed since: [ Place of work | | | Bfultime % workload headquarters Ci branch / operating site | | i AVS-compulsory annual salary: Fr. Difield service home office | | | i Date and place ‘Stamp and signature | 08 _| per Ay ny overs ayers node been othe ni lovers nperan ofi deveist eeoers oun | G __ Verification by the authority of the applicant's residential municipality | We the euhonty of the apocant’sresdentlal muncalty, confirm having vei the listed persone’ dentias if we found any inaccurate | lofeation we made the necessary corectins.| (09 | Date ‘Stamp and Signature H_ | Commitment and signature |e undersigned certy that al the information given inthis application Is tue and complete | take nate that family allowances pat onthe | ‘basis of flee formation o” concealment of facts wil hav tobe tetumed.Fuhermere. | m ebigated to mmecste inform the famiy aon | ances compensation offs ofall changes which could fluence the entement to slowanoes (eg. change ofc status numberof enidren | | re the place of residence ers of employment In the event of negigence or abuse, the faniyalloances compensation ofc is ale to | ake legal acten, | 19.0. 2015 CRAioveE le i Date and place BONANIAT Signature La ! 1D bith catia / ray book / proof oF legal quarianshi, in which the chs and both parents are mentioned | 07 extrac ofthe chorce decree conceming the ght of custody ore agreement on parental care io 0 confimaton fom the ote parents employer /famiy alowarces compensation ofcs of te other parent stating wheter family slowances sae aes pid or nt ‘apprenticeship corvact. enrolment confmation or other evidence of ongoing education fr chien after completion of tel 16th year Reset |