NAV 14 0506engelsk05 2014nettlagre

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Applying for parental benet, lump-sum grants or your maternal or

paternal quota upon a birth or adoption

NAV14-05.06 English Published12.2006 Amended 05.2014 Page 1

1.3 Do you live in Norway?

Yes No

Will you live in Norway continuously for 12 months or more? Short holidays

abroad are not considered to be ”living abroad”.

Yes

Have you lived in Norway continuously for the last 12 months? Short

holidays abroad are not considered to be ”living abroad”.

Yes No

If no, in which country have you been resident,

and in which period?

No

If no, in which country will you be resident,

and in which period?

1.1 Name of applicantNorwegian national identity number (fødselsnummer) (11 digits)

Street/road

Town

1.2 Address of applicant

Post code

Telephone number

Home

Mobile

Work

1. What are you applying for?

Parental benet for

mother with sole care

on birth/adoption

Parental benet and

the mother’s maternal

quota - adoption

Parental benet andthe mother’s maternal

quota - birthParental benet for

father on adoption

Parental benet for

father with sole care

on birth/adoption

Parental benet forfather on birth

Paternal quota for

father on adoption

Paternal quota forfather on birth

Lump-sum grant onbirth

Lump-sum grant on

adoption

The mother and father must apply separately. You cannot submit a joint application. (The gures in brackets apply to births and assumption of parental rights in an adoption up to 1 July 2014)

The total benet period for parental benet is 49 weeks with 100% coverage, or 59 weeks with 80% coverage. Parental benetcan be claimed no earlier than 12 weeks and no later than 3 weeks before your due date. This period is reserved for the mother.

A further 10 (14)-week maternal quota is also reserved for the mother. The rst 6 weeks after both are included in this quota. If

the father is also entitled to parental benet, a 10 (14)-week paternal quota is reserved for him. The father may start claiming no

earlier than 6 weeks after the birth. The rest of the parental benet period, 26 ( 18) weeks at 100% coverage and 36 (28) weeks at

80% coverage, is a shared period which the parents are free to split between them. The entire benet period must be continu-

ous. If you do not want the period to be continuous, you can apply for a postponement. This means that if, for example, the father

wants to postpone his paternal quota, he must apply for this no later than on the last day of the shared period in order not to lose

days of benet. Applications for postponements must be submitted using a special form, ”Postponement or graduated parental

benet (exible benet) - NAV 14-16.05”, which you can nd on Nav.no.

Nullstill



Employer or businessactivity

% posi-

tion

Period

––

––

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day daymonth year year month

Earnedincome

14 days

week

month

NAV14-05.06 English Published12.2006 Amended 05.2014 Page 2 PDF-versjon

When you apply for parental benet, you list your employment during the last ten months prior to the date for

withdrawal of the benet. In addition you give the last gross amount before the leave begins. If you apply for post-

ponement of the period with parental benet / paternal quota, you must document employment and income at the

time when you apply for postponement (tic off weekly, fortnightly or monthly disbursement):

2. Paid work

3. Birth

How many children are you expecting? How many children were born?

How many children under 15 years of age are being adopted?

4. Adoption

day year month

Date of assuming care:

2.2 CoverageParental benet for a birth can be paid at the rate of 80% for 59 weeks or 100% for 49 weeks; in the case of

adoption the rates apply for 56 and 46 weeks, respectively. The parents must choose the same coverage. If

only the father is entitled to parental benet, the rates apply for 50 weeks and 40 weeks, respectively. The

coverage chosen cannot be changed and will apply for the entire benet period, including the paternal quota.

100% coverage results in slightly higher total benet than 80% coverage.

100 per cent80 per centI choose

Sickness benet (sykepenger), attendance allowance (pleiepenger), care benet (omsorgspenger), workcapacity assessment allowance (arbeidsavklaringspenger), pregnancy benet (svangerskapspenger) orparental benet (foreldrepenger)

Unemployment benet (dagpenger)

2.1 Equivalent to paid work

When is the estimated date of delivery (due date)?(only to be completed by the mother)

day year month day year month

When did the birth take place?

(Conrmation of the due date

after the end of the 26th week of

pregnancy must be enclosed.)

Employee Selfemployed

If you are an employee, your employer must submit details of your income on NAV form 08-30.01

Period

––

––

––

––

day daymonth year year monthPay from employer while undergoing

training (lønn under utdanning)

Pay from employer after termination

of employment (etterlønn)

Military or civil conscript service

Severance pay (ventelønn) orinterim pay (vartpenger)




If the claim concerns a birth, the mother can start claiming parental benet no earlier than 12 weeks before and no later than 3

weeks before the due date. The weeks that are claimed for before the due date are deducted from the total benet period of 59 or

49 weeks. If the baby is born before the due date, the remaining days of the 3-week period are lost. If the baby is born after the

due date, the days between the due date and the date of the birth will be deducted from the shared period. In the case of an adop-

tion, the mother or father may claim parental benet at the earliest from the date custody commences.

5.4 The mother is applying for transfer of the paternal quota to herself The paternal quota may only be transferred to the mother if she has sole care of the child, the father is not en-

titled to parental benet or the father has been admitted to a health institution or is entirely dependent on help

with childcare because of illness. Tick below.

Sole care of the child/children

The father is not entitled to parental

benet

The father has been admitted to a health institution

The father is entirely dependent on help with

childcare because of illness

5. Period of leave - mother

This page must only be completed by the mother and only when it is the mother who is named as the claimant on page 1.

Do you want to claim for the entire maternal quota immediately after the birth?

Yes No

If no, write an explanation under section 7.

5.1 When do you want to start claiming parental benet?

day year month

5.2 Maternal quota

5.3 The mother wants to claim parental benet for a period that is not coveredby the maternal quota (shared period)

Do you want to claim for the entire shared period immediately after the maternal quota?

Yes No

If no, write an explanation in section 7.

If the parental benet period is to be postponed, due to vacation or full-time work, you must submit an application for this on a

separate form prior to the desired postponement period.



6.1 The father will claim his paternal quotaWhen the mother and father live together and both are entitled to parental benet, 10 (14) weeks are reserved for the father (paternal

quota). The paternal quota must, as a general rule, be claimed for as a continuous part of the shared period. The father can start

claiming for his paternal quota from the seventh week after birth at the earliest. In the case of an adoption, the father may claim for

his paternal quota at any time during the period. If the father does not want to claim for his paternal quota as a continuous part of the

shared parental benet period or immediately after the shared period, the father must apply for a postponement using a special form.

The father must apply for a postponement no later than the last day of the shared period in order not to lose paternal quota days.

State for which period(s) the father will be claiming for his paternal quota.


Paternal quota start date Paternal quota end date

6. Period of leave – father


This page should only be completed by the father, and only if the father is the named applicant on the rst page.

6.2 The father is to have parental benet that is not paternal (shared period)If the father is to have parental benet beyond the paternal quota, or if it is only the father who is entitled to parental benet,

there are requirements governing the status of the mother. Tick to show the mother’s status:

If the father has sole care of the child, he may draw parental benet at the earliest from the day he assumes care ofthe child. In such cases the mother is not entitled to parental benet once the father has assumed care.

State for which period(s) the father will be claiming parental benet.


Parental benet start date Parental benet end date

6.3 The father has sole care of the child

State the reason:

State for which period(s) of the shared period the father will be claiming parental benet.


Shared period start date Shared period end date

The maternal quota may only be transferred to the father if he is solely responsible for the care of the child, the

mother is not entitled to parental benet, the mother has been admitted to a health institution, or the mother, due to

illness, is completely dependent on help to care for the child. Tick the relevant alternative below:

6.4 Father applies to transfer the maternal quota to him

The mother is receiving disability pension

(uførepensjon)

1.

The mother is in full-time education/training3.

The mother is in education/training in combination

with work, totalling 100 per cent

4.

The mother is in work2.

The mother is participating in a qualication

programme for people with signicantly reduced

work and earning capacity

5.

The mother is participating in an introduction program-

me for recently arrived immigrants in accordance with

chapter 2 of the Introduction Act

The mother has been admitted to a health institution

The father is to take extra weeks as a result of a multiple

birth or adoption of more than one child

6.

8.

9.

The mother has an illness or injury that renders her enti-

rely dependent on help with childcare

7.

Sole responsibility for the care of the child(ren)

The mother has been admitted to a health institution

The mother is not entitled to parental benet

The mother is, due to illness, completely

dependent on help to care for the child(ren)




8. The other parent’s name

Street/road

Town

9. The other parent’s address

Post code

12. Declaration

11. Bank account number

10. Conrmation from the other parent

I conrm that the other parent has been informed of the periods for which I have claimed parental benet.

Yes No

If not, state the reason:

7. Additional information on the applicant, The applicant may use this eld if there is something not co-

vered by the form which he/she considers NAV should be aware of. Details of the other parent’s benets

should be stated in the application form for the other parent and not here as additional information.

Norwegian national identity number (fødselsnummer) (11 digits)

Your bank account number will be notied to NAV by the Norwegian Tax Administration. If you wish to see

which bank account number we are using, or to amend it, go to www.nav.no. Search for bank account number.

I have read and understood the terms and conditions for receiving parental benet.

I am aware that NAV may obtain any information necessary to process

this application.

I am aware that if I provide insufcient or incorrect information, I may be

required to repay benet received in error and/or be liable to prosecution.

Date Signature of applicant

Documents

NAV 14 0506engelsk05 2014nettlagre