Limosa declaration certificate (Document L1)

Belgium

Preceding declaration employee

Declaration submitted on 06/12/2022 16:52

Declaration number 24911 9332 0422 1012
Period of employment 15/12/2022 - 24/12/2022
Sector Electric installation works

Employee

Name Jardas First name Tommy

Belgian identification nr. 80.47.27-493.27

Company

VAT number HR33 2065 3410 6

Name SIN MARINE D.O.O.

Street DOBREC, Number 60, Box E

Postal code 51415 Municipality DOBREC LOVRAN

Country Croatia (Rep.)

Temporary work No

Place of employment

Name region Flanders

Name site Remi Claeys

Street Kortemarktstraat, Number 52
Postal code - Municipality 8810 - Lichtervelde

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Limosa Contact Center: tel: +32 2 788 51 57 (Monday to Friday, 7 AM - 8 PM, GMT+1) | e-mail: limosa@eranova.fgov.be

This form merely provides proof that a Limosa declaration has been made; it does not satisfy other obligations in
respect to the provision of services and/or employment in Belgium. See www.limosa.be.