TN 16 (11-96)

A. U.S. Swedish Agreement — General

A certificate of coverage serves as proof that the worker identified on the certificate is covered in the country which issued the certificate and that the worker and his employer are exempt from social security taxes in the other country for the period shown on the certificate. To obtain a certificate of coverage from a country, the employer or self-employed person must send a written request to the agency of the country which issues the certificate. Requests for certificates of coverage from the U.S. should be mailed to:

Requests for certificates of coverage from Sweden should be mailed to:

B. Information Required

The following information about the worker must be given when requesting a certificate from either country:

1. Full name

2. Date and place of birth

3. Country of citizenship

4. Country of residence

5. U.S. Social Security number (for U.S. certificates)

6. Swedish social security number (for Swedish certificates)

7. Name and relationship of any family members accompanying the worker

8. Address in Sweden (if known)

9. Name and address of employer in both countries (if self-employed, address of trade or business and nature of activity)

10. Place of hire (if employed)

11. Beginning and ending date of employment/self-employment in the other country.

C. Disposition of Copies

When a U.S. certificate is issued, an employee and employer copy will be sent to the employer or a single copy to a self-employed person. It will be the responsibility of the employer or self-employed person to present the certificate to the Swedish authorities when requested to do so.

When a Swedish certificate is issued, the employer or self-employed person will be provided with a copy. If the worker is employed, it is the responsibility of the employer to retain the copy and to present it to IRS if requested to do so. If the worker is self-employed, a photocopy of the certificate of coverage should be attached to his/her tax return each year.