Unemployment insurance
Employer’s certificate / Date of receipt
Surname and first name / Personnel no. / AHV (Swiss old age and survivors’ insurance no.)
Postcode, town, street, number / Date of birth / Marital status

Employers are required to provide truthful information and must maintain confidentiality vis-à-vis third parties (Art. 20, 88 AVIG; Art. 28 ATSG); they must in particular deliver the employer’s certificate to the insured person within a week of said person’s request.

Form of employmentThe form of employment immediately before leaving employment is decisive in answering the following questions.

1Type of employment
Full-time job
Part-time job
Teleworking / working
from home / Fixed-term
Temping/agency work
Seasonal job
Apprenticeship / Permanent
On-call job
Temporary employment / Work scheme for unemployed persons
2Length of employment / from / to
3Employed as

4Does the insured person or his/her spouse or registered partner have a share in the business or hold a managerial position (e.g. shareholder, board of directors in a plc or partner or MD in a private limited company, etc.) ?

yesno

5Normal working hours in the business / Hours per week
6The insured person’s normal contractual working hours / Hours per week

7Was there a written employment contract?yesno

8Was employment subject to a collective employment agreement?

yesCEA / no
9Which AHV compensation fund is the company affiliated to?

(Name and number)

Termination of employment

10Who gave notice? / When? / For what date of

verbally in writing (attach written notice)termination?

11Duration of the statutory or contractual notice period?

12Was the insured person unable to work due to illness, accident, pregnancy, military service, civil protection or civilian service at the time notice was given or during the notice period?

yes, due to / from / to / no nein

13Reason for notice ______

______

______

______

14Last day worked
15Wages were paid until

Periods of employment in the last 2 years

16Use a new line for each period of employment that follows a break in employment of at least one month.

from / to / Total earnings subject to AHV contributions
CHF
CHF
CHF
CHF

17Earnings

THE PAY SLIPS OR PAYROLL REGISTERS OF THE LAST 12MONTHS MUST BE INCLUDED WITH THE EMPLOYER’S CERTIFICATE

Last monthly wages / CHF

-The last time the ensured person received

a 13th monthly wage of CHF was on

a bonus of CHF was on

Last hourly wages: / Basic wage/
hours / Vacation pay / Holiday pay / 13th monthly wage / bonus / Total hourly wages
CHF / % / % / % / CHF

18Absences

Absences during the last 12 months on account of / fromto / fromto / fromto
Illness
Accident
Swiss military service, civil protection or civilian service
Unpaid vacation
Other reasons
19Is an annuity or pension being paid? / yes / CHF / per month / no

(attach supporting documents)

20What pension fund are employees ensured with under the Federal Act on Occupational Old Age, Survivors' and Invalidity Pension Provision?

21On termination of employment, did you grant the insured person further financial benefits in addition to wage entitlements?

yes / CHF / (attach supporting documents) / no

22Were child and/or training allowances paid?

yes / Number of child allowances / Number of training allowances / no

Place and date:Complete address / Valid signature / Company stamp

and

Tel.

Attached copies:Letter of notice

Pay slips for the last 12 months (section 17)

Supporting documents according to sections 19 + 21