Requesting Form PD U1
The purpose of this form UWV
This form enables you to request ‘Form PD U1’ from the UWV. Afdeling WW Internationaal
‘Form PD U1’ states the periods that you have been insured as an Postbus 20724
employee in the Netherlands. You need this form to apply for 1001 NS AMSTERDAM
unemployment benefit abroad. You can send this application within The Netherlands
4 weeks of the end of your employment contract.
After you have sent this form
What you should send with the application ‘Form PD U1’ will be sent to your home address within around
Send as much proof of your employment history with your 6 to 8 weeks.
application as possible. This enables us to process your application
more swiftly. More information
You will find more information at uwv.nl/internationaal.
Where to send the form You can also call the UWV Employees Telephone Desk on
After completing the form you can print it and send it, with any proof 088 898 92 94. If you are abroad, please call
you have (see Question 2.4) to the following address: +31 88 898 20 01 (the call charges depend on your telephone
provider). 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
1.1 Surname If you use the last name of your partner, please also fill out your birth name (maiden name).
Male Female
1.2 First name(s)
1.3 Address where ‘FormPD U1’ should be Street and house number
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 ‘FormPD U1’ Yes
before? No
2.2 In which country are you applying for
unemployment benefit?
2.3 How long did you work in the Use ‘Appendix 1 Statement of employment history’ to complete this question.
Netherlands for?
year(s)
AG140 15514 02-22 W Engels 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 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? YesEnclose a copy of the decision.
4.3 Was the employment contract ended No
via a UWV dismissal permit? YesEnclose a copy of the dismissal permit and notice of dismissal.
4.4 Was the employment contract ended No
via a termination or settlement YesEnclose 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 NoContinue to Question 6.1.
in your employment history YesIf 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
AG140 15514 02-22 W Engels 2 of 6
Appendix 1 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 02-22 W Engels 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 02-22 W Engels 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 02-22 W Engels 6 of 6
