Payment of remuneration – declaration[M1]
Please note:The following information is required to pay out your remuneration. Please see the attached data protection leaflet for
information on the legal provisions on the basis of which your data are collected. If the information is voluntary, this will
be marked in the form.
1. / Personal details / Please tick or fill in, as appropriate
Name / First name / Personnel number/area of work
Name at birth if different / Date of birth / Telephone (voluntary)
Address (street, post code, place of residence) / Nationality
Place of birth / Country of birth / Sex / Academic degrees
Name of entity/office and place of work
Marital status
Fill in this section only, if you are entitled to receive family-related benefits; otherwise the information is voluntary
□ / single
□ / married
□ / registered civil partnership
□ / divorced / marriage annulled or declared void
□ / widower
Account number, institute, sort code
Have you received a salary from Land Baden-Württemberg in the past?
□ / no
□ / Yes, under personnel no.:
Paying office:
2. / Tax details
My tax reference number is:
□ / My income tax card / tax office confirmationis attached
□ / The LBV already have my income tax card / tax office confirmation under the personnel number:
Your income tax calculation is done on the basis of the tax criteria stated on your income tax card that is provided to us.
As long as we do not have your income tax card we are obliged to do the income tax calculation on the basis of tax bracket 6.
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3. / Details regarding family-related benefits3.1 / Applies only, if you are a legal clerk (Rechtsreferendar):
If your marital status is one of the following:
married
divorced and you have to pay maintenance
single or divorced and you accommodate another person (e. g. a child) in your household and you support this person
widowed
you must
fill in the declaration for the family allowance (formLBV 538b1).
Please attach appropriate proof of your marital status, e. g. marriage certificate, operative provisions ofthe divorce decree including a note that it is binding and final, etc.
3.2 / This applies only if you have one or more children, have been employed for more than six months and wish to apply for child allowance forthe first time or if you already receive child allowance from a different family fund:
Please fill in the child allowance form (form LBV KG 1oed „Antrag auf Zahlung von Kindergeld an Angehörige des öffentlichen Dienstes“ – application for payment of child allowance for public service employees).
Declaration
I am aware that the details provided by memay influence the amount of my remuneration. I confirm that the above information is both accurate and complete.
I am aware that I am obliged to immediately notify in writing any changes regarding this declaration to the Landesamt and that I will have to repay any excess amounts that were paid due to inaccurate information or failure to notify changes.
I am also aware that claims arising from the employment will lapse, if I fail to assert them in writing within the exclusion period of 6 months following such claims becoming due.
Date, signature
Landesamt für Besoldung und
Versorgung Baden-Württemberg
70730 Fellbach
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Data protection information leaflet
for employees and trainees
1. General
From the day you start work and/or your employment commences, we are responsible for determining and paying out your remuneration and your child allowance and assistance*, if relevant. For this, we need your personal data. We collect such data through forms which you receive either from us or from your human resources department. Alternatively, you can download the forms from our internet pages at Tothe extent that we collect data that we do not necessarily need to fulfil our tasks but that facilitate our work significantly, for example your telephone number, we marked this in the form.
We use your data only to fulfil the tasks assigned to us by legislation and/or regulations by the state government and the finance ministry regarding the areas of responsibility of Landesamt für Besoldung und Versorgung Baden-Württemberg (LBVZuVO). We do not disclose or otherwise transmit your personal data, unless we are obliged do so by law.
2. Legal provisions on the basis of which we collect your data
-Section 13 Landesdatenschutzgesetz (LDSG) – state data protection act
-Sections 36 LDSG, 113 (4) Landesbeamtengesetz (LBG) state civil servants act, and the relevant administrative provisions (VwV-LBG)
-section 28 o Fourth Social Security Code (SGB IV)
-LBVZuVO and the relevant administrative provisions (VwV for LBVZuVO)
As a family fund we are responsible under section 72 subsection 1 income tax act - Einkommensteuergesetz (EStG) for determining and making child allowance payments. We collect the required data on the basis of the provisions of the income tax act pertaining to child allowance, in particularsection 62 et seqq. and section 68 EStG.
3. Processing and storage of your personal data
Your salary can only be calculated and paid out electronically.
Some of the incoming mail is collected electronically. To do this and to store your data we use a document management system (DMS) and a calculation programme. To calculate your assistance* we use a special secure programme.
The following personal data is stored:
-Personal data (e. g. name, first name, title, date of birth, place of birth, sex, nationality, address)
-Bank details
-Marital status, personal data ofthe spouse and children, if relevant
-Remuneration criteria (e. g. Remuneration bracket)
-Details regarding a supplementary pension
-Details regarding social security
-Work department
-Scope and duration of employment
-Tax criteria (e. g. tax bracket, religious denomination, personal allowances)
-Details regarding contributions to capital formation, if relevant
-Details regarding salary foregone, if relevant
-Basic data for assistance (e. g. insurance)*
Diagnostic data are not stored.*
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4. Disclosure/transfer of data
Tothe extent that we are legally obliged to do this, we will disclose part of your data to the following agencies that need the information to fulfil their tasks.
This includes in particular:
-The tax administration
-Social security carriers (e. g. the responsible health insurance provider, the German pension insurance)
-Agency to which capital forming contributions are paid over, if relevant
-Agency to which salary foregone is paid over, if relevant
-Relevant health insurance provider
-German pension insurance
-Versorgungsanstalt des Bundes und der Länder, VBL (Pension Institution of the Federal Republic and the Länder, VBL), if relevant
-Versorgungsverband bundes- und landesgeförderter Unternehmen e.V.,VBLU (Pension Association of Companies supported by the Federal Republic and the Länder, VBLU), if relevant
-Bayerische Versorgungskammer (Bavarian Pension Fund), if relevant
-Pension scheme of a professional guild, if relevant
-the responsible family fund, if relevant
-the employer of the spouse (in case of employment in the public service or equivalent), if relevant
The information needed by your bank to transfer your salarywill be disclosed tothem.
Assistance data or documents will be disclosed to entities outside the assistance administration only in exceptional cases and with your consent (e. g. health board, experts).*
* Note:
Only employees whose employment commenced prior to 01/10/1997 and whose employment has not been interrupted since are entitled to receive assistance under a collective agreement.
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[M1]Please make sure to also fill in LBV 42101s and LBV 42101z. (Exception: research assistants, student assistants, law clerks, working pensioners do not have to fill in LBV 42101z)