update: 05.12.2013

Please use regular updates of the “PWI”: http://www.itm.lu  search under „Formulaires / communication de détachement“ Please complete “PWI” in Word (avoid manuscript) and forward to following address:

INSPECTION DU TRAVAIL ET DES MINES (LABOUR AND MINING INSPECTORATE)„Posted and Illegal work office“ B.P. 27L-2010 Luxemburg

Address : 3, Rue des Primeurs L-2361 STRASSEN

OR e-mail to : detachement@itm.etat.lu

Helpline : (+352) 247 – 86232 Fax number: (+352) 247 - 90288

Information about posting of workers to Luxemburg („PWI“)

I. Posting employer

Employer / Corporate name of company      Legal form of company (Ltd, etc..)      Name & first name of company manager      Exact powers of head of company(C.E.O., manager, etc..)

     

Registered office Street & Nr.      Postcode/ town      (Member-)State      

Posting branch, subsidiary company (where applicable)

Street & Nr.      Postcode/ town      (Member-)State      

Phone number      Mobile phone number      Fax number      E-mail-address (mandatory) @Nature of activities      Link to collective bargaining agreement in country of origin

yes noif yes, please indicate which one :      

Employer’s skilled person for occupational safety and health management at work (“OSH”)(Directive 89/391/EC)

Name & first name      Phone number      

Luxembourg VAT No.1 LU             -          Luxembourg registration No.                      

1 NB. : VAT must be paid in Luxemburg in accordance with Council Directive 2006/112/EC of 28th November 2006 on the common system of value added tax. Contact : Administration de l’Enregistrement et des Domaines (www.aed.public.lu / ),Bureau d’imposition 10, B.P. 31, L-2010 Luxembourg Phonenumber : +352 44905-609 Email :lux.imp10@en.etat.lu

update: 05.12.2013

Acknowledgement of receipt of the Prior declaration issued by “Ministère des Classes Moyennes et du Tourisme” (Ministry of Middle Classes and Tourism) (www.mcm.public.lu)

Please copy HERE (*) the original french wording from the acknowledgement of receipt !!

Or, if not yet available ►►►

N° C                 /  

Activités prestées sur le territoire du Grand-Duché de Luxembourg :(services provided on Luxembourg territory )

(*)……………………………………………………………………………

Please join proof of the prior declaration for occasional and temporary services on the Luxembourg territory to the abovementioned Ministry,accompanied by a EU-certificate issued by the competent Employers Chamber or professional association from the Member State of origin,or any other document certifying that the posting company is lawfully established and authorized in its country of origin to provide the services it wants to provide in Luxembourg.

II. Temporary holding person (“THP”)

Name and first name(s)      Precise address of documents holding in Luxembourg

Street & Nr.      Postcode & town L-     

Phone number:      Mobile phone number:      Fax number :      E-mail-address      

III. Posted workers

If more place is needed, please attach a list containing at least the same information

List attached: yes no (Please tick)

Name First name

Date of birth

(dd/mm/yy)Nationality Job description Effective

professionEffective

posted activity

1                                          2                                          3                                          4                                          5                                          6                                          7                                          8                                          9                                          

10                                          11                                          12                                          13                                          14                                          15                                          16                                          17                                          18                                          

update: 05.12.2013

IV. Posting of workers to Luxembourg

A) General data

Starting date of posting      Likely duration      Type of services provision carried out      

Place (construction site) where posted work is provided (full address)

Name :      Street & Nr.:      Postcode / town:      

B) Do you directly use posted temporary workers?

yes no (please tick) If yes:

Corporate data of temporary work agency Address, postcode & town (Member-)State

                                  

A prior authorization by “Ministère du Travail et de l’Emploi” ( Ministry of Labour & Employment ) is compulsory for every posting temporary work agency which provides directly staff to a user (undertaking) in Luxembourg.

C) Do you directly use hired-out posted workers?

yes no (please tick) If yes:

Corporate data of original employer hiring-out posted workers to Luxembourg Address, postcode & town (Member-)State

                                  

A prior authorization by “Ministère du Travail et de l’Emploi” is compulsory for every original posting employer, who lends staff directly to an end - user or undertaking in Luxembourg.

D) Do you work with posting subcontractors?

yes no (please tick) If yes:

Name of the subcontractor Address, postcode & town (Member-)State                                  

Please inform each of your posting subcontractors, that a separate forwarding of a completed “PWI” to ITM is mandatory.

E) Are you a posting subcontractor?

yes no (please tick) If yes:

Name of your direct contractor: Address, postcode & town (Member-)State                 

Compulsory for every posting subcontractor to separately forward a completed “PWI” to ITM

update: 05.12.2013

V. List of documents required in Luxembourg

Please only tick boxes corresponding to COPIES of documents actually (physically) kept by the “THP” (in a clearly identified and accessible location) for control authorities ITM & CUSTOMS, during the full posting period in Luxembourg.

On request of ITM, following documents have to be translated into an official language (french or german) of the host Country.

1) WORKING CONTRACTS of all posted workers (such as indicated under III) Code of Labour law, First Book, Title II (working contract)or:COMPLIANCE CERTIFICATES, issued by the country of origin’s competent authority. (Mandatory information of all posted workers by the employer about the working contract/relation conditions.) Directive 91/533/EC2) TIME CONTRACTS WITH TEMPORARY WORK AGENCIES OR WORKFORCE LOANERS in case of use of temporary or loaned posted workers Code of Labour law, Art. L. 142-3.1

3) SUBCONTRACTING AGREEMENTS between contractors and subcontractors

4) A1-FORMS (formerly E101-Forms), providing information on the belonging of posted workers to social security network in country of originor :FULL CONTACT DETAILS OF COMPETENT SOCIAL SECURITY BODY during their stay Regulations 883/2004 EC and 987/2009 EC5) ACKNOWLEDGEMENT OF RECEIPT OF THE PRIOR DECLARATIONfor occasional & temporary services on Luxembourg territory, issued by the Ministry of Middle Classes and Tourism (http://www.mcm.public.lu) Code of Labour law, Book V, Title VII concerning « black labour »or :

PROOF OF PRIOR DECLARATION to a.m. Ministry, for occasional and temporary services on Luxembourg territory, accompanied by a EU or EES certificate issued by the competent Employers’ Chamber or professional association from the Member State of origin, or by any other document certifying that the posting company is regularly established and authorized in the latter, to provide given services in Luxembourg. Directive 2005/36/EC : Articles 5 & 7 & 50.16) HEALTH FITNESS CERTIFICATES FOR WORKissued by the sectorially qualified OCCUPATIONAL HEALTH SERVICES (Labour Doctors) in country of origin. Exceptionally, such State certified services of the guest-Country may deliver above mentioned certificates (against payment by posting employer) (www.stm.lu (general) / www.sti.lu (industry) / www.astf.lu (finance) Code of Labour law, Art. L. 326-17) LUXEMBOURG VAT CERTIFICATEIssued by the „Administration de l’Enregistrement et des Domaines” (Record Office and Land Registry) http://www.aed.public.lu Council Directive 2006/112/EC8) WORK & RESIDENCE PERMIT (for Citizens of outer European Economic Space(“EES”) )Issued by “Direction de l’Immigration” (http://www.mae.lu) under Ministry of Foreign affairs Code of Labour law, Art. L. 572-3

Date of «PWI» (dd/mm/yy)     

Name / signature of the head (CEO) of posting undertaking (or proxy-holding deputy)“PWI” by e-mail: please scan

Posting employer:       Company LOGO/Seal

Name:      

Signature: