Application for Confirmation of Employment Record for a Preferential Pension
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PENSION FUND OF UKRAINE Kharkiv |
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To the Pension Fund of Ukraine Office in the Shevchenkivskyi District |
APPLICATION
for Confirmation of Employment Record
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Applicant: Petro Ivanov |
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Address: 12 Vesela St., Apt. 123 |
Telephone: (066) 222-30-58 |
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Passport: |
Series: VN |
Date of issue: 01.01.2001 |
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Number: 658940 |
Date of birth: 15.03.1956 |
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Issued by: Dzerzhynskyi District Department of the Ministry of Internal Affairs of Ukraine in Kharkiv Region |
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I request that my application for confirmation of employment periods in positions entitling me to a pension on preferential terms / a pension for years of service (underline as appropriate) for the following period be considered: ________________________.
To confirm the above employment record, I submit the following documents:
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No. |
Document |
Quantity |
Returned to Applicant |
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Date |
Applicant’s Signature |
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1. |
Information concerning state registration of the termination of the legal entity |
3 |
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2. |
Employment record book |
1 |
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3. |
Documents issued by archival institutions: |
8 |
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Salary certificate |
1 |
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Copies of documents concerning workplace certification for hazardous and/or special working conditions |
3 |
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Copies of documents concerning transfers to other work, transfer to part-time work, and unpaid leave (where no such events occurred, a certificate confirming their absence) |
4 |
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Date: 15 March 2021 Applicant’s Signature: _______________
