Application form to determine

social insurance liability

Application form
in an EU or EFTA Member State
SF-F6-10EU-EN
after permanent departure
Page 1/3 from Switzerland

To be completed by the applicant

Date of leaving Switzerland 31.08.2022

(Frontier workers: end of employment activity)

1. Applicant

Last name Minea

Last name

Other last names

Please separate all other last names with a «/»

Forename Cosmin

Forename

Other forename

Please separate all other forenames with a «/»

Date of birth 01.07.1987

Nationality Romanian
Personal identity
document No. 060936672

AHV-No. 756.2273.2023.36

Address in the
EU / EFTA country Intrarea Horbotei 2
LOB Guarantee Fund RO-030466 Bucharest
Business Office
P. O. Box 1023
3000 Berne 14
 Last address
in Switzerland Uetilbergstrasse 111A

8045 Zurich
Application form
SF-F6-10EU-EN

Page 2/3

Telephone number / email
(for any queries) +40723283420, cosmin.minea@gmail.com

2. Pension fund

Pension fund / Vested
benefits foundation Publica
in Switzerland
(name and address) Eigerstrasse 57

3007 Bern

Contract number

Last employer in
Switzerland ETH, Zurich
(name and place)
Rämistrasse 101

8093 Zurich

3. Conclusion

The applicant authorises the LOB Guarantee Fund, for the purpose of passing on occupa-
tional benefit credit balances, to disclose his personal data to the competent body in an
EU/EFTA country and authorises the competent body of a EU/EFTA country to inform the
LOB Guarantee Fund of the outcome of the enquiries. The LOB Guarantee Fund is likewise
authorised to inform all the parties involved (account keeping establishments and person
making the application) of the outcome of the enquiries.

The applicant confirms the accuracy of the above information.

Place, date Zurich, 22/07/2022

Signature
* EU/EFTA states are as follows:
Belgium, Bulgaria, Croatia, Denmark,
Germany, Estonia, Finland, France,
Greece, Republic of Ireland, Italy,
The competent occupational benefit scheme examines the conditions for a cash payment
Latvia, Lithuania, Luxembourg, Malta,
and payment of the vested benefit.
Netherlands, Austria, Poland, Portugal,
Romania, Sweden, Slovakia, Slovenia,
Spain, the Czech Republic, Hungary
and Cyprus respectively Iceland,
Liechtenstein, Norway and Switzerland
 Application form
SF-F6-10EU-EN The following documents must be attached
to the application:
Page 3/3
Copy of a passport or identity card
Copy of confirmation of departure from the local authority
of residence
Frontier workers: evidence of termination of the employment
relationship in Switzerland (with precise date)
Copy of the insurance certificate or calculation of
vested benefit from last occupational benefit scheme

The form is to be completed, signed and sent to:

LOB Guarantee Fund
Business Office, P. O. Box 1023, 3000 Berne 14
Email: info@sfbvg.ch

Confirmation from the foreign body

will be obtained by the LOB Guarantee Fund

Date of examination

The competent body confirms that the above person

on the date of examination
is subject to the state pension insurance.
is not subject to the state pension insurance.

Place, date

Signature, stamp

LOB Guarantee Fund

Business Office
P. O. Box 1023
07/2021

3000 Berne 14

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