Division List of forms

E 001	— Request for information, communication of information, request for forms, reminder on an employed person a self-employed person, a frontier worker, a pensioner, an unemployed person, a dependant
E 103	— Exercising the right of option
E 104	— Certificate concerning the aggregation of periods of insurance, employment or residence
E 105	— Certificate concerning the members of the family of an employed person or self-employed person to be taken into consideration for the calculation of cash benefits in the case of incapacity for work
E 106	— Certificate of entitlement to sickness and maternity insurance benefits in kind for persons residing in a country other than the competent country
E 107	— Application for a certificate of entitlement to benefits in kind
E 108	— Notification of suspension or withdrawal of the right to sickness and maternity insurance benefits in kind
E 109	— Certificate for the registration of members of the employed or self-employed person's family and the updating of lists
E 110	— Certificate concerning employed persons in international transport
E 111	— Certificate of entitlement to benefits in kind during a stay in a Member State
E 112	— Certificate concerning the retention of the right to sickness or maternity benefits currently being provided
E 113	— Hospitalization: notification of entering and leaving hospital
E 114	— Granting of major benefits in kind
E 115	— Claim for cash benefits for incapacity for work
E 116	— Medical report relating to incapacity for work (sickness, maternity, accident at work, occupational disease)
E 117	— Granting of cash benefits in the case of maternity and incapacity for work
E 118	— Notification of non-recognition or of end of incapacity for work
E 119	— Certificate concerning the entitlement of unemployed persons and the members of their family to sickness and maternity insurance benefits
E 120	— Certificate of entitlement to benefits in kind for pension claimants and members of their family
E 121	— Certificate for the registration of pensioners and the updating of lists
E 122	— Certificate for the granting of benefits in kind to members of the family of pensioners
E 123	— Certificate of entitlement to benefits in kind under insurance against accidents at work and occupational diseases
E 124	— Claim for death grant
E 125	— Individual record of actual expenditure
E 126	— Rates for refund of benefits in kind
E 127	— Individual record of monthly lump-sum payments

Notes on Attachment

Textual amendments

F1: Deleted by Decision No 202 of 17 March 2005 on model forms necessary for the application of Council Regulations (EEC) No 1408/71 and (EEC) No 574/72 (E 001, E 101, E 102, E 103, E 104, E 106, E 107, E 108, E 109, E 112, E 115, E 116, E 117, E 118, E 120, E 121, E 123, E 124, E 125, E 126 and E 127) (Text with EEA relevance and for the EU/Switzerland Agreement) (2006/203/EC).
F2: Deleted by Decision No 198 of 23 March 2004 concerning the replacement and discontinuance of the model forms necessary for the application of Regulations (EEC) No 1408/71 and (EEC) No 574/72 of the Council (E 110, E 111, E 111 B, E 113, E 114, E 119, E 128 and E 128 B) (Text with EEA relevance and the EU/Switzerland Agreement) (2004/562/CE).
F3: Substituted by Decision No 179 of 18 April 2000 on the model forms necessary for the application of Council Regulations (EEC) No 1408/71 and (EEC) No 574/72 (E 111, E 111 B, E 113 to E 118 and E 125 to E 127) (Text with EEA relevance) (2002/154/EC).
F4: Substituted by Decision No 187 of 27 June 2002 on model forms necessary for the application of Council Regulations (EEC) No 1408/71 and (EEC) No 574/72 (E 111 and E 111B) (Text with EEA relevance) (2003/251/EC).
F5: Substituted by Decision No 198 of 23 March 2004 concerning the replacement and discontinuance of the model forms necessary for the application of Regulations (EEC) No 1408/71 and (EEC) No 574/72 of the Council (E 110, E 111, E 111 B, E 113, E 114, E 119, E 128 and E 128 B) (Text with EEA relevance and the EU/Switzerland Agreement) (2004/562/CE).
F6: Deleted by Decision No 168 of 11 June 1998 on the amending of forms E 121 and E 127 and the discontinuance of form E 122 (Text with EEA relevance) (98/443/EC).