Application for unclaimed holiday allowance (earned in 2013 for the 2014/2015 holiday year) You only need to complete this form to apply for disbursement of unclaimed holiday allowance if: A. the amount relates to the fifth week of holiday (holiday earned over and above nine and a half months' employment), or B. the amount relates to a period of employment ending no later than 30 April 2015. Remember to read the guidelines on pages 4-5 before you complete the form. 1. Personal details Civil registration (CPR) number Name Address Email Postcode Town/city Telephone Mobile 2. Information about holiday allowance I request disbursement of my unclaimed holiday allowance for The have been calculated based on a 5-day working week 6-day working week The holiday allowance is to be disbursed by FerieKonto Employer or holiday card administrator 3. Disbursement by employer or holiday card administrator If the holiday allowance is to be disbursed by an entity other than FerieKonto, please state which (employer/holiday card administrator) No. Name Commercial Register (SE) no. Address Email Postcode Town/city Telephone Mobile 4. Reason for application (tick one of the following two options) Box 4A (fifth week of holiday) The holiday allowance relates to the fifth week of holiday. (Remember to complete box 5) Box 4B (end of employment period) The holiday allowance was earned during a period of employment ending no later than 30 April 2015. (Remember to complete box 5) Remember to submit the application by 30 September 2015 to the entity which is to disburse your holiday allowance. See, however, box 5.
5. Information about public benefits received during the holiday year 1 May to 30 April 2015. Have you received unemployment benefits (arbejdsløshedsdagpenge), special training subsidies særlig uddannelsesydelse), temporary employment benefits (midlertidig arbejdsmarkedsydelse), cash benefits (kontantydelse), early retirement pension (efterløn), benefits under the Danish flexi job scheme (fleksydelse), unemployment benefits for persons accepted onto a subsidised flexible employment scheme (ledighedsydelse) or direct social security benefits (kontanthjælp) during the holiday year? (Sickness benefits and maternity/paternity benefits are not included.) If yes, please state the number of for which you have received No. benefits. Indicative calculation Yes No You have stated that you: Wish to have unclaimed holiday allowance disbursed for During the holiday year, you have received public benefits for You are therefore entitled to unclaimed holiday allowance for If the number is 0 or negative, it means that you have received public benefits for the same or a greater number of than the number of for which you are claiming unclaimed holiday allowance. In that case, you are not entitled to disbursement of unclaimed holiday allowance. For information about alternative ways of claiming disbursement of unclaimed holiday allowance, please visit www.borger.dk/feriepenge (in Danish). 6. Bank details (FerieKonto will pay the holiday allowance into your NemKonto) If your employer does not know your NemKonto details, you must state them here. Reg. no. Account no. You must now print the form in order to be able to date and sign it. 7. Employee's signature I hereby solemnly declare, under penalty of the law, that the information I have provided is correct. I also declare that I have read the application guidelines. Date Signature Remember 8. Information from employer or holiday card administrator (to be completed by the entity disbursing the holiday allowance) Based on this application, I have disbursed The amount disbursed No. corresponds to The holiday allowance has been disbursed by Days DKK The amount is stated before tax after tax Commercial Register (SE) no. Address Email Postcode Town/city Telephone Mobile I hereby solemnly declare, under penalty of the law, that the information I have provided is correct. I also declare that I have read the application guidelines. Date Signature Remember
Where do I submit the form? If you answered 'Yes' to having received public benefits during the holiday year 1 May 2014 to 30 April 2015: Please submit the form to: The Danish Agency for Labour Market and Recruitment Njalsgade 72 A DK-2300 Copenhagen S I will send the form to the Danish Agency for Labour Market and Recruitment (tick the box to continue) If you have NOT received public benefits during the holiday year and are applying for disbursement of: unclaimed holiday allowance relating to the fifth week of holiday, or unclaimed holiday allowance relating to an ended period of employment Please submit the form to the entity which is to disburse your holiday allowance. To FerieKonto: To your holiday card administrator: To your current employer: If you have received a letter from FerieKonto concerning your holiday If you have received a holiday card. The holiday card administrator appears from the holiday card. If you are entitled to paid holiday (only applies to applications for the fifth week of holiday) Please note: You should NOT submit the form to the Danish Agency for Labour Market and Recruitment. I will NOT submit the form to the Danish Agency for Labour Market and Recruitment (tick the box to continue)
Guidelines for employees You may only apply for disbursement based on this form from 1 May 2015 to 30 September 2015. You will forfeit your right to disbursement of holiday allowance based on this form if you apply later than 30 September 2015. If unclaimed holiday allowance is disbursed to you based on this form, your usual public benefits may be reduced. For more information about this, please contact the authority disbursing the benefits. Guidelines for completing the individual boxes Box 2 You must state the number of of holiday for which you wish to claim holiday allowance. If you receive payment in lieu of untaken of holiday, the remaining number of of holiday appears from your holiday card. If you are entitled to paid holiday, your employer can inform you how many of holiday you have left. You must state whether you holiday allowance has been earned based on a 5-day or a 6-day working week. Holiday allowance is normally calculated on the basis of a 5-day working week. Holiday allowance disbursed by FerieKonto is always based on a 5-day working week. You must state if an entity other than FerieKonto is to disburse your holiday allowance. If you receive payment in lieu of untaken of holiday, the entity which is to disburse your holiday allowance is indicated on your holiday card. If you are entitled to paid holiday, the holiday allowance will be disbursed by your employer. Box 5 You must state the benefits you have received during the holiday year. You must answer 'Yes' if you have received: unemployment benefits special training subsidies temporary employment benefits cash benefits early retirement pension benefits under the Danish flexi job scheme unemployment benefits for persons accepted onto a subsidised flexible employment scheme direct social security benefits (sickness benefits and maternity/paternity benefits are not included). If you have not received any of the above-mentioned benefits, you must answer NO. This applies, for example, if you have only received sickness benefits or maternity/paternity benefits. You must state the number of for which you have received benefits during the holiday year. If you are in doubt, you can contact your unemployment insurance Please note: If you have received benefits during the holiday year 1 May 2014 to 30 April 2015, the number of for which you claim holiday allowance will be reduced by the number of for which you received benefits. If you have received one or more of the above-mentioned benefits for the same or a greater number of than the number of for which you are claiming holiday allowance, you are not entitled to holiday allowance under these rules. This applies regardless of the amount of benefits disbursed per day. Box 7 Remember to date and sign the form. Please note that you are signing a solemn declaration. If the amount is disbursed to you even though you do not meet the conditions for disbursement, the Danish Agency for Labour Market and Recruitment may order you to pay the holiday allowance to the Danish Labour Market Holiday Fund. If you have provided incorrect information or failed to disclose information, and the amount has been wrongly disbursed to you, you may also be reported to the police. Box 8 This box must be completed by the entity disbursing the holiday allowance. You must complete one form for each application. Checks After having disbursed the holiday allowance, your employer, holiday card administrator or FerieKonto must retain the form for one year after expiry of the application deadline to enable the Danish Agency for Labour Market and Recruitment to make subsequent spot checks. The information provided on this form may be checked, for example against information obtained from employers, public authorities or unemployment insurance funds. Checks may also be performed by cross-checking national registers. You will be notified if your application is selected for checking. The Danish Agency for Labour Market and Recruitment must also advise you that your information may be passed on to third parties for scientific purposes, e.g. statistics, analysis and research, and to other public authorities for use in connection with national register cross-checks. Under the Danish Act on Processing Personal Data (Persondataloven), you are entitled to know what information the Danish Agency for Labour Market and Recruitment holds on you. If you wish to exercise this right, you must contact the Danish Agency for Labour Market and Recruitment.
fund or local authority. You are entitled to have incorrect or misleading information corrected or deleted.
Guidelines for employers and holiday card administrators When may I disburse unclaimed holiday allowance based on this form? Holiday allowance may be disbursed after 1 May 2015. Disbursement may not be made if the employee has submitted the form after 30 September 2015. Please also note that you may only disburse holiday allowance under these rules if the employee has completed this form or another form approved by the Danish Agency for Labour Market and Recruitment. What do I do when I receive the form? Before you make the disbursement, you must make sure that the employee has completed all required fields on the form. You risk having to pay the same amount again to the Danish Labour Market Holiday Fund if the employee has not completed all required fields and it turns out that he or she was not entitled to the amount in question. If the employee answered 'Yes' in Box 5 and still submitted the form to you, you must forward the form to the Danish Agency for Labour Market and Recruitment as soon as possible. After having processed the application, the Danish Agency for Labour Market and Recruitment will notify you only if the disbursement may be made. How do I complete and retain the form? You only need to complete Box 8. You must state the amount you deposited to the employee's account. You must also state whether the amount was disbursed before or after tax etc. as well as the number of of holiday to which the amount corresponds. Finally, you must state the name of your company or the name of the holiday card scheme as well as the Central Business Register (CVR)/Commercial Register (SE) number. After having disbursed the unclaimed holiday allowance to the employee, you are required to retain the form for one year after expiry of the application deadline. The reason for this is that the Danish Agency for Labour Market and Recruitment must subsequently be able to perform spot checks to verify whether the disbursement was correct. If you fail to do so, you may be reported to the police.