Requesting Form E301/PD U1 via the internet

To apply for unemployment benefit abroad

The purpose of this form If you are unable to email the documents, you can print the
This form enables you to request Form E301/PD U1 from the UWV. form and send it with any proof you have to the following
Form E301/PD U1 states the periods that you have been insured as address:
an employee in the Netherlands. You need this form to apply for
unemployment benefit abroad. You can send this application within UWV
4 weeks of the end of your employment contract. Afdeling WW Internationaal
Postbus 124
What you should send with the application 7550 AC HENGELO
Send as much proof of your employment history with your The Netherlands
application as possible (see Question 2.4). Usually we can process
applications within 2 weeks. It will take longer to process your After you have sent this form
application without proof (up to a maximum of 6 weeks). After you have sent this form to the UWV, Form E301/PD U1
will be sent to your home address within around 6 to 8 weeks.
Where to send the form
After completing the form, email it together with your proof (see More information
Question 2.4) to uwv.verdragen@uwv.nl. You will find more information at uwv.nl/internationaal. You
can also call the UWV Employees Telephone Desk on
0900 898 92 94.
If you are abroad, please call +31 88 898 20 01. The UWV
assistant will talk to you in Dutch.
Please keep your citizen service number to hand when you
call, so that we can provide you with the best possible service.

What am I signing for

Declaration of intent I have provided correct and complete information about me and my situation on this form.
1.1 Surname 1 Personal details
If you use the last name of your partner, please also fill out your birth name (maiden name).
1.1 Surname
      Male Female

1.2 First name(s)      

1.3 Address where Form E301/PD U1 Street and house number      
should be sent to
Postcode and place            

Country      

1.4 Citizen service number      

1.5 Date of birth      

1.6 Place of birth      

1.7 Nationality      

1.8 Telephone number      

1.9 E-mail address      

2 About your situation

2.1 Have you received Form E301/PD U1 Yes

before? No

2.2 In which country are you applying for      

unemployment benefit?
Use Appendix 1 Statement of employment history to complete this question.
2.3 How long did you work in the
Netherlands for?       year(s)

AG140 15514 09-17 W 1 of 6

2.4 Send as much proof of all the Indicate which form of proof you are sending.
employment relationships that you
Copy of your employment contract.
had in this period as possible.
Copy of your salary slips from the last past 3 months.
Copy of your employer's statement(s) (period(s) worked and reason for leaving).
Copy of your resignation letter (if applicable).
Copy of the subdistrict court's decision to terminate the employment relationship (if
applicable).
Copy of the UWV dismissal permit and notice of dismissal (if applicable).
Copy of termination/settlement agreement (if applicable). This must have been signed by
both parties.
3 Last employer

3.1 Company name      

3.2 Address Street and house number      

Postcode and place            

Country      

3.3 Profession or type of activities      

3.4 Period you worked there From       to and including      
4 Reason your last employment relationship ended

4.1 Why was the employment ended? Employee resigned.

Dismissed by employer.
Employment contract ended.
Employment contract was ended by mutual agreement.
Summary dismissal.
Dismissed for business reasons.
Activities/secondment activities ended.

Other reason      

4.2 Was the employment contract ended No

by the subdistrict court? YesEnclose a copy of the decision.

4.3 Was the employment contract ended No

via a UWV dismissal permit? YesEnclose a copy of the dismissal permit and notice of dismissal.

4.4 Was the employment contract ended No

via a termination or settlement YesEnclose a copy of the termination/settlement agreement. This must have been
agreement? signed by both parties.
5 Other employers

5.1 Have you had more than 1 employer NoContinue to Question 6.1.
in your employment history YesIf you had more than 2 employment relationships in that period, enter the 3rd and
according to Appendix 1 State of other other employers in Appendix 2 Other employers. If there is not enough room,
employment history per country? you can send a separate sheet of paper.

Company name      

Address      

Postcode and place            

Country      

Period you worked there

From       to and including      

6 Any additional information

6.1 Please provide any additional      

information you wish to send here.

7 Signature

Date and signature      

2 of 6
 Appendix 2 State of employment history per country
In columns 2 and 5

Country in which you are applying The employment history that we need
for unemployment benefit

Belgium provide your past 3 years' employment history in the Netherlands

Bulgaria provide your full employment history in the Netherlands

Cyprus provide your past 3 years' employment history in the Netherlands

Denmark provide your past 3 years' employment history in the Netherlands

Germany provide your past 5 years' employment history in the Netherlands

Estonia provide your full employment history in the Netherlands

Finland provide your full employment history in the Netherlands

France provide your past 3 years' employment history in the Netherlands

Greece provide your past 3 years' employment history in the Netherlands

Hungary provide your past 4 years' employment history in the Netherlands

Ireland provide your past 3 years' employment history in the Netherlands

Iceland provide your past 2 years' employment history in the Netherlands

Italy provide your past 2 years' employment history in the Netherlands

Croatia provide your full employment history in the Netherlands

Latvia provide your full employment history in the Netherlands

Liechtenstein provide your past 2 years' employment history in the Netherlands

Luxembourg provide your past year's employment history in the Netherlands

Malta provide your full employment history in the Netherlands

Norway provide your past 3 years' employment history in the Netherlands

Austria provide your full employment history in the Netherlands

Poland provide your full employment history in the Netherlands

Portugal provide your past 3 years' employment history in the Netherlands

Romania provide your full employment history in the Netherlands

Slovenia provide your full employment history in the Netherlands

Slovakia provide your past 4 years' employment history in the Netherlands

Spain provide your past 6 years' employment history in the Netherlands

Czech Republic provide your past 3 years' employment history in the Netherlands

United Kingdom provide your past 3 years' employment history in the Netherlands

Sweden provide your past 8 years' employment history in the Netherlands

Switzerland provide your past 2 years' employment history in the Netherlands

AG140 15514 09-17 W 3 of 6

 Appendix 2 Other employers
Continued in column 5

3 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

4 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

5 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

6 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

7 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

8 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

AG140 15514 09-17 W 5 of 6

9 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

10 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

11 Company name      

Address Street and house number      

Postcode and place            

Country      
Period you worked there From       To      

12 Company name      

Address Street and house number      

Postcode and place            

Country      

Period you worked there From       To      

AG140 15514 09-17 W 6 of 6