eForm - Parental / Adoption leave Trust Claim

Employer Details

P.E. Number

Company's Name

Contact Details

Name / Number

Street

Locality

Post Code

Contact Number

Email

Representative

Identity Card Number

Name

Surname

Bank Account Details

Bank's Name

IBAN

This number will replace any IBAN the employer may have previously registered with the Department.

Claim Details

The employee on whom the claim is being made.

Identity Card Number

Name

Surname

Indicate Working Days per Week

Indicate the number of children for whom a claim is being made

Child’s Identity Card Number

Child’s Full Name

Child's Date of Birth

Period of Claim

Indicate the correct start and end dates of Parental / Adoption Leave availed by the employee in the fields below. The period must be that of at least two (2) weeks per claim; or no longer than four (4) weeks per claim if the child is under the age of four (4).

Age of Child

0 - 4

5 - 6

7 - 8

Sickness Benefit Married Rate (€)

Date From

Date To

Number of Weeks Entitled

Age of Child

Total (€)

Add second claim (0 - 4)?

Yes

No

Sickness Benefit Married Rate (€)

Date From

Date To

Number of Weeks Entitled

Age of Child

Total (€)

Sickness Benefit Married Rate (€)

Date From

Date To

Number of Weeks Entitled

Age of Child

Total (€)

Sickness Benefit Married Rate (€)

Date From

Date To

Number of Weeks Entitled

Age of Child

Total (€)

Documents Required

Pay Slips for wage/salary paid during Parental / Adoption Leave.

Maximum file size: 1MB

FS3 of the preceding calendar year.

Maximum file size: 1MB

Social Security Contributions receipts issued by the Commissioner for Revenue (CfR), covering one (1) year before the Parental / Adoption Leave Claim.

Maximum file size: 2MB

In the case of Adoption, an Adoption Certificate is required.

Maximum file size: 1MB

In the case of separated parents / adoptive parents, the claiming parent / adoptive parent has to provide certified evidence that he/she enjoys the legal custody of child.

Maximum file size: 1MB

List of Company Employees from JobsPlus, indicating employment commencement date at least one (1) year prior to the Parental / Adoption Leave Claim.

Maximum file size: 1MB

Declaration

Department of Social Security Declaration

I declare that all information given is to my knowledge true, complete and correct. I understand that if the information given is false, I will be penalised as stipulated in the Criminal Code (Cap. 9.) and can also lose the right for benefit, or part of it, as stipulated by the Social Security Act (Cap. 318.).

I understand that as stipulated in Article 133 of the Social Security Act (Cap. 318.), the Director General (Social Security) may make necessary investigations and may ask persons and/or entities to provide information so that the benefit will be calculated and determined.

I bind myself to inform immediately of any change in circumstance to the Director General (Social Security). If the Director General (Social Security) is not informed of such change in circumstance, entitlement for the benefit or part of may be forfeited.

I understand that if for some reason or another, it is found that I was not entitled for this benefit, I will have to refund all payments received.

Reimbursements are granted on the assumption that the applicant is the rightful beneficiary and that the amount claimed is correct and due. The Board of Trustees reserves the right to institute any and all legal proceedings available to it.

I accept the Data Protection Declaration

Data Protection Declaration The Department of Social Security collects all relevant personal information to provide its services to individuals who qualify for assistance, allowance or non-contributory pensions in accordance with the Social Security Act (Cap. 318.). The Department may verify the information submitted by you in line with article 133 (b) of the Social Security Act to ensure its accuracy in relation to the claim. Personal data may be disclosed to departments / third parties, who may also have access to your data as authorised by law. Personal information may also be exchanged with benefits institutions of other countries to combat and deter fraud, as provided for in international treaties or bilateral agreements to which Malta is a party. You will be informed in due course of the result of your claim after it has been assessed.

Pursuant to the General Data Protection Regulation (EU) 2016/679 (GDPR) and the Data Protection Act (Cap. 586.), we have a legal duty to respect and protect any personal information we collect from you and we will abide by such duty. We take all safeguards necessary to prevent unauthorised access and we do not pass on your details collected from you as a visitor and/or user, to any third party unless you give us your consent to do so or as authorised by law. You may request in writing to access information held about you, and eventually to rectify, and where applicable to erase incorrect information. Such a request is to be addressed to “The Data Controller”, Department of Social Security, 38, Ordnance Street, Valletta VLT 1021 or by email to dpsocialsecurity.dssc@gov.mt and appropriate action would be taken at the earliest possible time. In making such a request, kindly quote your identity card number, social security number, your name and address and other relevant documentation to identify your case.

Insert email address here to receive a copy of your application.

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