REGULATION OF THE MINISTER OF LABOUR AND SOCIAL POLICY ¹⁾

of 7 December 2011

on the lists, applications and payments of benefits from the Guaranteed Employee Benefits Fund

• Metric
• Codified text

On the basis of art. 22 of the Act of 13 July 2006. the protection of employees ' claims in the event of the insolvency of the employer (Dz. U. No 158, pos. 1121, of late. 1. ²⁾ ) The following shall be managed:

§ 1. The Regulation shall specify:

1) specimens of the lists and applications referred to in art. 15 para. 1 and 2, art. 16 ust. 1 and Art. 17 para. 2 of the Act of 13 July 2006. the protection of employees 'claims in the event of the insolvency of the employer, hereinafter referred to as' the Act ';

2. mode:

(a) the submission of lists and applications referred to in Article 15 para. 1 and 2, art. 16 ust. 1 and Art. 17 para. 2 of the Act,

(b) the transfer of financial resources of the Guaranteed Employee Benefits Fund, hereinafter referred to as the "Fund",

(c) the payment of benefits from the Fund.

§ 2. The formulae shall be:

1) an aggregate list of unsatisfied employee claims referred to in art. 15 para. 1 of the Act, hereinafter referred to as "the list",

2. the supplementary list referred to in Article 2. 15 para. 2 of the Act,

3) the request submitted by the person referred to in art. 16 ust. 1 and Art. 17 para. 2 of the Act, hereinafter referred to as 'individual application'

-which are Annexes 1 to 3 to the Regulation.

§ 3. 1. The list shall be prepared in writing by the employer, the receiver, the liquidator or any other person holding the management of the employer's assets referred to in art. 15 para. 1 of the Act, hereinafter referred to as "the storer" respectively, and is submitted in three unimpleting copies to the Marshal of the competent voivodship due to the registered office of the insolvent employer.

2. The list shall be accompanied by:

1) a copy of the current copy from the Register of Entrepreneurs in the National Court Register or a copy of the current certificate of entry in the records of the business activity, or information from the Central Register and Information on Economic Activity, called hereinafter referred to as "CEIDG", or a copy of the current certificate of entry in the Register of Representations of Foreign Entrepreneurs kept by the Minister responsible for the economy;

2) a certified copy of the certificate of the granting of the REGON identification number containing the current employer's data and the tax identification number of the NIP or an authenticated copy of the current confirmation of the granting of the tax identification number of the NIP, o How many have been granted

3) the current certificate of the institution in which the bank account is held for the holder of the list, with the number of that account;

4. an authenticated copy of the order of the court stating one of the reasons for the insolvency of the employer referred to in art. 3 para. 1 or Art. 6 para. 1 point 3, or art. 8 ust. 1 points 1 and 3 of the Act, or certified copies of documents stating the existence of one of the conditions for the insolvency of the employer referred to in Art. 8 ust. 1 points 2 and 4-6 of the Act;

5) an authenticated copy of the document setting out the day of the employer's insolvency, referred to in art. 3 para. 2 or Article 6 para. 2, or Art. 8 ust. 2 of the Act;

6) a statement by the applicant for the benefit of the members of the staff members who are entitled to the benefit of the members who are entitled to the benefit of the members of 8 of the Act of 13 March 2003. with special rules for the resolution of labour relations workers on the grounds of non-employees (Dz. U. No 90, pos. 844, as late. 1. ³⁾ ), and their height;

7. a statement by the applicant operator stating:

(a) that the staff included in the list to which social security contributions have been charged to the benefit of the benefit fund, in the year in which the payment of the benefits are made, have not reached the limit of the annual basis the assessment of the pension contributions for the calendar year concerned, referred to in Article 4 (1) of the Financial Regulation. 19 of the Act of 13 October 1998. o Social Security System (Dz. U. 2009 r. Nr 205, pos. 1585, as of late. 1. ⁴⁾ );

(b) where the staff referred to in (a) have reached this year the amount of the limitation of the annual basis for the contributions that the accrued contributions to the pension scheme, as shown in the list, contain contributions to the limited amount indicated in the list of contributions a statement, a dimension, or that they do not include contributions to the pension insurance;

(8) a declaration by the operator of the interest rate in force for the accident insurance contributions for accidents at work and occupational diseases, as established in accordance with the Act of 30 October 2002. o social insurance in the field of accidents at work and occupational diseases (Dz. U. 2009 r. Nr 167, pos. 1322, with late. 1. ⁵⁾ );

(9) certified copies of the work certificates of persons with whom the employment relationship has been resolved.

§ 4. 1. The provisions of paragraph 3 shall apply mutatis mutandis to supplementary lists.

2. Where an applicant has not submitted a list, the documents referred to in paragraph 3 (1) shall be attached to the first supplementary list. 2 points 1 to 6 and 9.

3. Where an applicant has submitted a list or submits another supplementary list, he shall not attach the annexes thereto, except for the declaration referred to in paragraph 3 (1). Article 2 (6), and the documents referred to in paragraph 3 (6), 2 point 9.

§ 5. 1. The Marshal of the voivodship shall transfer two copies of the accepted list to the submitting entity, and then transfer the financial resources referred to in art. 15 para. 4 of the Act, for the bank account referred to in § 3 par. 2 point 3.

2. The applicant, immediately upon receipt of the accepted list and financial means, shall not later, however, than within 7 days from the date of receipt, pay the benefits to the persons entitled, on the basis of the list accepted by the Marshal Voivodship

3. The applicant shall not later than 30 days from the date of receipt of the financial resources:

1. it shall transfer to the bank account from which it has received it, the difference between the amount of funds received and the amount paid to the rightholders;

2) return to the marshal of the voivodship one copy of the list containing the confirmation of the owner's signature of the receipt of the benefits by the persons entitled or copies of confirmations of payment of the benefits of the postal transfer or transfer;

3) transfers to the Marshal of the voivodship a certified copy of the confirmation of the recovery of advances on personal income tax, the contributions to health insurance and social security and the transfer of maintenance duties.

4. The provisions of the paragraph. 1-3 shall apply in the case of supplementary lists.

§ 6. 1. The individual application shall be made in the form of a written marshal of the voivodship competent due to the seat of the insolvent employer in two mond-sounding copies.

2. The individual application shall be accompanied by:

1) where the applicant is a person who is an employee, a former employee, a employed person or a person who has been employed on a different basis than the employment relationship referred to in art. 10 of the Act-statement of the applicant that during the period for which the employees ' claims covered by the individual application were unmet, the person was not the spouse of the employer, as well as his/her own child, the child of the second spouse or child with an opportunity, parent, stepmother or stepfather or adopter, as well as siblings, grandchildren, grandfather, son-in-law, son-in-law, brother-in-law, sister-in-law or brother-in-law and the person engaged in gainful employment in the household referred to in art. 10 laws;

2) where the applicant is entitled to a survivor's pension member of the family of the deceased employee, deceased former employee, deceased person, who was employed on a different basis than the employment relationship referred to in art. 10 of the Act, a statement by the applicant that the deceased person was not the spouse of the employer, as well as his own child, the child of the second spouse or child of the adopted, parent, stepmother or stepfather or adoptive person as well as siblings, grandchildren, grandparent, son-in-law, son-in-law or daughter-in-law, brother-in-law, sister-in-law or brother-in-law and the person engaged in gainful employment in the household referred to in art. 10 laws;

3) evidence confirming the entitlement to benefit by the applicant from the benefits specified in the Act.

3. In the case referred to in paragraph. Article 2 (2), the individual application shall also be accompanied by documents proving the death of the person referred to in paragraph 2. Article 2 (1), and the entitlement of the applicant to the survivor's pension.

§ 7. The Marshal of the voivodship, to which an individual application has been submitted, shall apply to the entity referred to in art. 15 para. 1 of the Act, or to a person authorized, within the meaning of the provisions on freedom of business activity, to represent a foreign entrepreneur in a branch or representation, or a person representing a credit institution, or, as appropriate, a foreign insurance undertaking, indicated in an individual application, with a request for transfer within 7 days:

1) documents relating to the entity referred to in § 3 par. 2 points 1 and 2;

2) documents concerning the date and circumstances of the occurrence of the employer's insolvency, referred to in § 3 (3) 2 points 4 and 5;

3) statements concerning the employee or former employee, referred to in § 3 (3) 2 points 6 and 7;

4) the document referred to in § 3 par. 2 point 9;

5) statements of the total amount of unsatisfied employees ' claims of employee, former employee, employed person or persons who were employed on a different basis than the employment relationship referred to in art. 10 of the law to which an individual application relates, specifying the amounts, the titles of payments and the periods of non-payment of those claims to a person entitled to them;

6) information concerning the deductions of maintenance claims from the remuneration of the person referred to in § 6 (1) In accordance with the provisions laid down in the Act of 26 June 1974, paragraph 1 shall be carried out by the Commission. -Labour Code (Dz. U. 1998 r. No 21, pos. 94, z późn. 1. ⁶⁾ ).

§ 8. 1. The Marshal of the voivodship shall notify the authorized person and the entity or person authorized, referred to in § 7, of the date and amount authorized to the payment of the benefit fund, shall make the payment of benefits from the Fund to the person entitled to benefits: a transfer to a bank account indicated by a person entitled or a postal transfer.

2. In the case where the person entitled is the applicant referred to in § 6 par. 2 point 1, the marshal of the voivodship makes payment of social security contributions, health insurance and advances on income tax from natural persons and makes deductions and transfers maintenance receivables.

3. In the case where the person entitled is the applicant referred to in § 6 par. 2 point 2, the marshal of the voivodship makes the payment of advances on income tax on natural persons.

§ 9. 1. In the case where the Marshal of the voivodship finds that in the period between the date of submission of the list or the supplementary list and the date of transfer of funds to the bank account referred to in § 3 par. Article 2 (3), and the transfer of the accepted list or the supplementary list to the operator, has changed the amount of the average monthly remuneration referred to in Article 2 (2). 14 para. 1 of the Act, the Marshal of the voivodship shall without delay notify the applicant of the need to reassemble the list or the supplementary list referred to in § 3 (3). 1, which takes into account the current amount of that remuneration.

2. In the case of the application of the individual marshal of the voivodship approves for the payment of the benefit, taking into account the amount of the average monthly remuneration in force on the day of payment referred to in § 8 (2). 1.

§ 10. The applicant entity or the authorised person referred to in § 7 and the persons entitled shall notify the Marshal of the voivodship of any change of circumstances affecting entitlement to benefits from the Fund's resources.

§ 11. This Regulation shall enter into force on 1 January 2012. ⁷⁾

Minister of Labour and Social Policy: W. Kosiniak-Kamysz

¹⁾ The Minister of Labour and Social Policy heads the government administration-work, pursuant to § 1 paragraph. 2 point 1 of the Regulation of the Prime Minister of 18 November 2011 on the detailed scope of the action of the Minister of Labour and Social Policy (Dz. U. Nr. 248, pos. 1485).

²⁾ The amendments to the said Act were announced in Dz. U. of 2008 No. 237, item. 1654, of 2009 Nr 6, pos. 33, No 125, pos. 1035 and No. 157, pos. 1241, of 2010 Nr 18, pos. 100 i No 257, pos. 1726 and 2011 No. 112, item. 654 and No. 197, pos. 1170.

³⁾ The amendments to the said Act were announced in Dz. U. 2003 r. No 213, pos. 2081 and No. 223, pos. 2217, 2004 Nr 96, pos. 959, of 2005 No. 62, item. 551, 2006 Nr 79, pos. 550 and Nr. 149, pos. 1077 and 2008 Nr 86, pos. 525 and No. 237, pos. 1654.

⁴⁾ Amendments to the text of the single law have been announced in the Dz. U. 2009 r. No. 218, item. 1690, of 2010 Nr 105, pos. 668, Nr 182, poz. 1228, No. 225, pos. 1474, Nr 254, poz. 1700 and No 257, pos. 1725 and 2011 Nr 45, poz. 235, Nr. 75, pos. 398, Nr 138, pos. 808, No. 171, pos. 1016, No. 197, pos. 1170, No 199, pos. 1175 and No. 232, pos. 1378.

⁵⁾ Amendments to the text of the single law have been announced in the Dz. U. of 2010 Nr 257, pos. 1725 and 2011 Nr 45, poz. 235, No 122, pos. 696 and No. 138, pos. 808.

⁶⁾ Amendments to the text of the single law have been announced in the Dz. U. 1998 r. No. 106, pos. 668 i Nr 113, poz. 717, 1999 Nr 99, pos. 1152, of 2000 No 19, pos. 239, Nr 43, pos. 489, No. 107, pos. 1127 and No. 120, pos. 1268, 2001 No 11, pos. 84, Nr 28, pos. 301, Nr 52, pos. 538, Nr 99, pos. 1075, Nr 111, poz. 1194, No 123, pos. 1354, Nr 128, poz. 1405 and No. 154, pos. 1805, of 2002. No. 74, item. 676, No. 135, pos. 1146, No. 196, item. 1660, Nr 199, pos. 1673 and No. 200, pos. 1679, 2003 Nr 166, pos. 1608 i Nr 213, poz. 2081, 2004 Nr 96, pos. 959, Nr 99, pos. 1001, Nr 120, poz. 1252 and No. 240, pos. 2407, of 2005 Nr 10, pos. 71, Nr 68, poz. 610, Nr 86, pos. 732 and No 167, pos. 1398, of 2006. Nr 104, pos. 708 and 711, No. 133, pos. 935, Nr 217, poz. 1587 and No. 221, pos. 1615, 2007 No. 64, pos. 426, Nr. 89, pos. 589, Nr 176, pos. 1239, Nr 181, pos. 1288 and No. 225, pos. 1672, 2008 Nr 93, pos. 586, Nr 116, pos. 740, No. 223, pos. 1460 and No. 237, pos. 1654, of 2009 Nr 6, pos. 33, Nr 56, poz. 458, Nr 58, poz. 485, Nr. 98, pos. 817, Nr 99, poz. 825, No. 115, pos. 958, Nr 157, poz. 1241 and No. 219, pos. 1704, of 2010 Nr 105, pos. 655, Nr 135, poz. 912, Nr 182, poz. 1228, No 224, pos. 1459, Nr 249, poz. 1655 i No 254, pos. 1700 and 2011 No. 36, pos. 181, Nr 63, poz. 322, No 80, pos. 432, No 144, pos. 855, Nr 149, poz. 887 i No 232, pos. 1378.

⁷⁾ This Regulation was preceded by the Regulation of the Minister of Labour and Social Policy of 28 February 2007. on the lists, applications and payments of benefits from the Guarantee Fund Guarantee Fund (Dz. U. Nr 53, pos. 356), which is repealed with effect from 1 January 2012. based on art. 70 points 2 and art. 123 point 4 of the Act of 27 August 2009. -Provisions introducing a law on public finances (Dz. U. Nr. 157, pos. 1241 and No. 219, pos. 1706, 2010 Nr 96, pos. 620, Nr 108, pos. 685, Nr 152, poz. 1020, Nr 161, poz. 1078, Nr 226, poz. 1475 and No. 238, pos. 1578 and 2011 No. 171, item. 1016, Nr 178, pos. 1061 and No. 197, pos. 1170).

Annex 1. [ MODEL-CUMULATIVE LIST OF UNMET EMPLOYEE CLAIMS IN THE PERIOD PRECEDING THE EMPLOYER ' S INSOLVENCY DAY]

Annexes to the Regulation of the Minister of Labour and Social Policy
of 7 December 2011 (pos. 1635)

Annex No 1

MODEL- CUMULATIVE LIST OF UNMET EMPLOYEE CLAIMS IN THE PERIOD PRECEDING THE EMPLOYER ' S INSOLVENCY DAY

Annex A to the summary list of unmet employee claims

LIST OF UNSATISFIED WORKERS 'CLAIMS ACCORDING TO THE TITLES REFERRED TO IN ARTICLE 12 (2) OF THE LAW FROM THE PERIODS PRIOR TO THE DATE OF THE EMPLOYER' S INSOLVENCY

Explanatory notes to the collective list of unsatisfied workers ' claims in the period preceding the date of the employer's insolvency (list):

¹⁾ The list is the employer, liquidator, receiver or other person holding the employer's property, the designation of which is to be indicated.

When completing the list of employers employing disabled persons shall take into account the social contributions of these persons only if the provisions relating to the rehabilitation of occupational and social handicapped persons impose on the payer and the insured person's obligation to pay contributions from their own resources.

²⁾ Marshal of the voivodship due to the registered office of the insolvent employer.

³⁾ Indicate the appropriate premise of the employer's insolvency among those laid down in the Article. 3 para. 1 or in Art. 6 para. 1 point 3, or in Article 8 ust. 1 of the Act of 13 July 2006. the protection of employees ' claims in the event of the insolvency of the employer (Dz. U. No 158, pos. 1121, of late. zm.), hereinafter referred to as the "Act".

⁴⁾ The compliance of the data in columns 1 and 2 of the summary list with Annex A applies to the list of unsatisfied employees ' claims according to the titles laid down in the Article. 12 (1) 2 of the Act on the periods prior to the date of the employer's insolvency. In column 2, the PESEL number may be replaced by the number of the document stating the identity. Columns 1 to 19 of the aggregate list and columns 1 to 35 of Annex A shall be completed by the operator referred to in point 1 of the explanatory notes. The cumulative list and Annex A shall be drawn up as from No 1 of the number of ordinals, the persons remaining in employment on the date of the employer's insolvency; then the persons with whom the employment relationship has been terminated:

-on the date of the employer's insolvency,

-in the following days preceding the date of insolvency of the employer (the date of termination of the employment relationship is more distant from the date of the employer's insolvency, the former employee should continue to be included).

Prior to the submission of the summary list, the entity shall consult the Marshal of the voivodship of the applicable average monthly remuneration of the previous quarter, as referred to in point 7 of the explanatory notes.

According to the provision of art. 13 of the Act, where the cumulative list is made in relation to the insolvency of the employer who has applied for it again, the provisions relating to the settlement of claims by the Fund may not be re-applied to those the employees themselves in respect of the same claims, with claims from the titles listed in the Article. 12 (1) 2 point 1, point 2 (b) a-c and lit. (g) and point 3 of the Act shall be satisfied for a total period of not more than three months. Therefore, when the cumulative list is submitted in connection with the reinsolvency of the employer, only persons who are to be included in the summary list and in Annex A shall be included in the summary list and Annex A.

1) claims were not met in the event of a previous insolvency or

2) persons whose total claims by the title:

(a) remuneration for work,

(b) remuneration for the time not hinged by the employee of the downtime, for the duration of non-work (dismissal) and for the time of another justified absence at work,

(c) remuneration for the duration of the worker's incapacity to work as a result of the illness referred to in Article 92 of the Labour Code,

(d) remuneration for the time of holiday leave,

(e) the compensatory allowance referred to in Article 230 and 231 of the Labour Code, and

(f) social security contributions payable by employers

-have been satisfied for a period of less than three months.

In the case of the persons referred to in point 2 above, the broken number shall be used in Annex A: the serial number/order number in the summary list submitted and executed on the previous insolvency.

⁵⁾ The persons covered by the definition of the worker referred to in Article shall be taken into account. 10 of the Act (excluding persons from this definition excluded), and the persons referred to in art. 11 of the Act. The summary list and Annex A shall not take into account former employees with whom the employment relationship has ceased more than 9 months prior to the date on which the employer's insolvency was due to occur. In column 4 of Annex A, the date of cessation of the employment relationship of the employee whose claims are not met if, on that date, entitlement to the benefit of the Fund is associated, on the basis that the employment relationship has ceased to be met. occurred within a period of not more than nine months prior to the date of the employer's insolvency or on the date on which the employer's insolvency was due.

⁶⁾ Indicate the employment relationship, the other legal basis for the benefit of the work for which the social security obligation arises.

⁷⁾ Columns 5 to 7 must be filled in with respect to Art. 14 para. 1 of the Act, stipulating that the total amount of the benefit for a period of one month may not exceed the average monthly remuneration of the previous quarter, as of the day of its announcement by the President of the Central Statistical Office in the Official Journal The Republic of Poland "Monitor Polski", advertised on the basis of art. 20 point 2 of the Act of 17 December 1998. o pensions from the Social Insurance Fund (Dz. U. 2009 r. No. 153, pos. 1227, of late. zm.).

In the event of a re-occurrence of the employer, in respect of persons whose claims, at first insolvency, have been satisfied for a period of less than 3 months, the columns 5 to 7 must be claimed for the period constituting the padding to a three-month period. The current average monthly salary should be taken into account. Where the period of completion does not cover the full month, the average monthly remuneration shall be taken into account in a fractional part of that amount, proportional to the period of the incomplete month for which the claims are subject to the veil.

Where data relating to four calendar months are reported in Annex A, column 5 (I-month) data shall be reported as the sum of the two periods in two separate calendar months ("I calendar month" and "IV"). the calendar month "), which is the total of the data for one full calendar month.

⁸⁾ Column 8 shall be fulfilled in the light of Article 3. 14 para. 2 of the Act, which provides that the amount of the cash equivalent benefit for the annual leave referred to in Article 2 (1) of the Act of the European Council of the European Commission 171 § 1 of the Labour Code, due in respect of the calendar year in which the employment relationship has ceased, may not exceed the amount of the average monthly remuneration referred to in point 7 of the explanatory notes.

⁹⁾ Columns 9 and 10 must be completed taking into account the Article. 14 para. 3 of the Act, which provides that payment of the compensation payment for the shortening of the period of notice referred to in Article 3 (1) of the Act of the European Council 361 § 1 of the Labour Code shall not exceed the amount of the average monthly remuneration referred to in point 7 of the explanatory notes or a multiple thereof where the amount of the benefit is a multiple of the salary giving rise to it. findings.

¹⁰⁾ Columns 9 to 13 of the aggregate list and columns 30 to 34 of Annex A shall be completed taking into account the provisions of the Article. 12 (1) 5 of the Act, that the benefits of unpaid briegings, as well as compensation, are met from the Fund's resources when termination of the work occurred in a period of not more than 9 months prior to the date of the employer's insolvency or on the date on which the employer's insolvency is due.

¹¹⁾ Column 15 must indicate the amount to be used for the social security contributions determined by the amounts shown in columns 5 to 8, which, in accordance with the provisions of the Law of 13 October 1998, are the basis for the social security contributions. o Social Security System (Dz. U. 2009 r. Nr 205, pos. 1585, as of late. zm.) and with the provisions of the Ordinance of the Minister of Labour and Social Policy of 18 December 1998. on the detailed rules for setting the basis for the assessment of contributions to pension insurance (Dz. U. Nr 161, poz. 1106, of late. zm.) form the basis of the dimension of these contributions. In the columns 16 to 19, enter the amounts of social security contributions referred to in Article 4. 12 (1) 2 point 3 of this Act, financed from the employer's funds. Account should also be taken of the applicable employer's interest rate for accident insurance for accidents at work and occupational diseases, which is in accordance with the Act of 30 October 2002. o social insurance in the field of accidents at work and occupational diseases (Dz. U. 2009 r. Nr 167, pos. 1322, with late. zm.).

¹²⁾ Columns from 20 to 22 of the summary list shall be completed by the Marshal of the voivodship, after having established that the total amount of the benefits accruing from the Fund shown in column 14 was established in accordance with the provisions of the Act, and the amounts of contributions shown in columns from 16 to 19 do not raise objections:

-enter the amount in column 14 in column 20,

-enter the amount in column 16 in column 21.

In column 22, enter the sum of the amounts in columns 20 and 21.

¹³⁾ Columns 23 to 30 of the list shall be completed by the operator referred to in point 1 of the explanatory notes after having received two copies of the list referred to in paragraph 5 of the Regulation.

The advance payment on personal income tax shall be calculated in accordance with the provisions of the Act of 26 July 1991. o Income tax on individuals (Dz. U. of 2010 No. 51, item. 307, of late. (m) including, after deduction of the amounts of the pension contributions, the pension and sickness insurance contributions, shown in columns 26 to 28, financed by the insured funds, fixed respectively on the amounts shown in column 20. The amounts of the contributions to the pension, disability and sickness insurance contributions, by analogy as advance payments on personal income tax and sickness insurance contributions, from the amount authorised to be paid, shown in column 20, shall be collected and discharged to the public the relevant institution of the entity to which the funds from the Fund are transferred.

In the calculation of the premiums, shown in columns 26 to 28, they shall be calculated on the amounts shown in column 20, respectively, i.e. after considering:

-the rules laid down in the Article. 19 of the Act of 13 October 1998. o the social security scheme that contributions to the pension scheme from the benefits claimed for the benefit of the benefit fund will be calculated by those employees who have not reached the current year the amount of the annual basis the assessment of pension contributions for a given calendar year,

-the provisions of the Act of 13 October 1998. the social security system and the provisions of the Regulation of the Minister of Labour and Social Policy of 18 December 1998. on the detailed rules for setting the basis for the assessment of the contributions to pension insurance, i.e. on the amounts which form the basis of contributions.

In column 23, the amount of the advance payment on personal income tax should be entered, calculated accordingly (i.e. after deduction of the amounts of the social security contributions financed by the insured person/employee) from the amount of the benefits shown in column 20, after deduction, in accordance with the provisions of Article 4 (1) of the basic Regulation. 95 of the Act of 27 August 2004. on health care services financed from public funds (Dz. U. of 2008 Nr 164, pos. 1027, of late. (m)-as shown in column 23-amount of the contribution to health insurance.

The deduction shall be subject to an amount not exceeding the interest rate for that contribution referred to in Article 4. 27b par. 2 of the Act of 26 July 1991. o Income tax on individuals (Dz. U. of 2010 No. 51, item. 307, of late. zm.).

In column 25, enter the amount of the health insurance premium, financed by the insured person, which represents the difference between the amount of the health insurance premium in force, which corresponds to the interest rate for that premium as laid down in the Article. 79 of the Act of 27 August 2004. on public health care benefits financed by public funds, and the rate of contribution corresponding to the interest rate of that contribution as laid down in the Article 27b par. 2 of the Act of 26 July 1991. o personal income tax.

¹⁴⁾ In column 24, enter the amount calculated at the interest rate specified in the Article. 27b par. 2 of the Act of 26 July 1991. o personal income tax.

¹⁵⁾ In column 30, enter the amount representing the difference between the amount in column 20 and the sum of the amounts of the deductions from the columns: 23 to 29. The deductions shown in columns 23 to 29 shall be collected and discharged to the competent institution of the entity on whose account the funds from the Fund have been transferred.

¹⁶⁾ Representation of the holder in accordance with the rules in force at the time of the civil law commitments.

¹⁷⁾ Salaries, as specified in Article 12 (1) 2 points 1 and 2 (a), (b) and (c) of the Law and compensatory allowances referred to in Article 2 (2) (a) (a) 12 (1) 2 point 2 (a) g of the Act, as well as the cash benefits referred to in art. 12 (1) 2 point 2 (a) d of the Act, entitled under the provisions of the Act of 13 March 2003. with special rules for the resolution of labour relations workers on the grounds of non-employees (Dz. U. No 90, pos. 844, as late. zm.), as well as the cash equivalent for the holiday leave referred to in art. 12 (1) 2 point 2 (a) the Act, and the damages referred to in art. 12 (1) 2 point 2 (a) (f) of the Act, it shall be shown in Annex A to the cumulative list in gross amounts due and to staff not paid.

Annex A shall be an extract from the source documents relating to the unsatisfied workers ' claims according to the titles laid down in the Article. 12 (1) 2 of the Act, and the salaries shown in Annex A in columns 5 to 9, 11 to 15 and 17 to 21 include:

in -remuneration for work,

Your -the remuneration for the time not hinged by an employee of the downtime referred to in Article 81 § 2 of the Labour Code, remuneration for the time of non-work (dismissal) referred to in art. 81 § 1 of the Labour Code, and the remuneration for the time of another justified absence at work-entitled to a worker on the basis of the universally applicable labour law,

of -remuneration for the duration of the incapacity for work as a result of the disease referred to in art. 92 of the Labour Code and in art. 18 (1) 2 of the Act of 13 October 1998. the social security system,

u -the remuneration for the period of holiday leave falling within the period referred to in Article 3 (1) (b) of the basic Regulation. 12 (1) 3 of the Act,

cc -the compensatory allowance referred to in Article 230 and 231 of the Labour Code.

In the event of a recurrence of the employer's insolvency, in respect of persons whose claims, at first insolvency, have been satisfied for a period of less than 3 months, only claims for the period of time should be indicated in Annex A being padded up to a three-month period.

The leave equivalent shown in Annex A, column 29, shall include the cash equivalent for the annual leave referred to in Article 4. 171 § 1 of the Labour Code, due in respect of the calendar year in which the employment relationship has ceased.

The claim shown in Annex A in columns 30 and 31 includes compensation for the shortening of the period of notice referred to in Article 3. 361 § 1 of the Labour Code.

¹⁸⁾ To be completed by the name of the month, where the claims cover the full calendar month period; otherwise, indicate the duration of the calendar month, which includes the reported receivables. To be completed under the provisions of Article 4 12 (1) 3 of the Act, that the salaries, as specified in the Art. 12 (1) 2 points (1) and (2) (a), (b) and (c) of the Act and the allowances referred to in Article 2 (2) of the 12 (1) 2 point 2 (a) G of the Act, are met by the Fund for a period of not more than 3 months prior to the date of the employer's insolvency or for a period of not more than 3 months preceding the day of cessation of the employment relationship, if the ratio is determined the work falls within not more than nine months preceding the date of the employer's insolvency or on that date.

For a "period of not more than 3 months", no more than three full calendar months or two full calendar months and the sum of two periods in two separate calendar months shall be understood to constitute a total of one (third) calendar month.

For 'I calendar month' means the calendar month in which the employer's insolvency day occurred (in the case of persons remaining in employment on that date), or the calendar month in which the termination of the employment relationship occurred.

For the "II calendar month", the month preceding "I calendar month" shall be understood.

For the "III calendar month", the month preceding the "II calendar month" shall be understood.

"IV calendar month" shall mean the month preceding "III calendar month" which will occur only if the employer's insolvency day or the day of termination of the employment relationship-occurs on a different date than the last day " I of the calendar month ".

Annex 2. [ MODEL-SUPPLEMENTARY LIST OF UNMET EMPLOYEE CLAIMS DURING THE PERIOD AFTER THE DATE OF THE EMPLOYER ' S INSOLVENCY]

Annex No 2

MODEL -LIST OF SUPPLEMENTARY UNMET EMPLOYEE CLAIMS DURING THE PERIOD AFTER THE DATE OF THE EMPLOYER ' S INSOLVENCY

Explanatory notes to the list of supplementary unsatisfied employee claims during the period after the date of the employer's insolvency (supplemental list):

¹⁾ The employer shall be the employer, the liquidator, the receiver or any other person holding the employer's assets, the designation of which shall be given.

²⁾ Marshal of the voivodship due to the registered office of the insolvent employer.

³⁾ Indicate the appropriate premise of the employer's insolvency among those laid down in the Article. 3 para. 1 or in Art. 6 para. 1 point 3, or in Article 8 ust. 1 of the Act of 13 July 2006. the protection of employees ' claims in the event of the insolvency of the employer (Dz. U. No 158, pos. 1121, of late. zm.), hereinafter referred to as the "Act".

⁴⁾ If a supplementary list is included in the supplementary list-in connection with the termination of the employment relationship after the date of the employer's insolvency-the person who was previously covered by the collective list (with a salary for a period of not more than three years) months prior to the date of the employer's insolvency), the number of ordinal/position of the collective list should be included in the supplementary list. In column 2, the PESEL number may be replaced by the number of the document stating the identity.

⁵⁾ The persons covered by the definition of the worker referred to in Article shall be taken into account. 10 of the Act (do not include the persons excluded from this definition), and the persons referred to in art. 11 of the Act. In column 4, indicate the date of cessation of the employment relationship of the employee whose employees ' claims have not been met.

⁶⁾ Employment relationship, other legal basis for the benefit of the work for which the social security obligation arises.

⁷⁾ Columns 12 to 16 must be filled in with respect to Art. 14 para. 3 of the Act, stipulating that the amount of the benefit for a period of one month may not exceed the average monthly remuneration of the previous quarter, as of the day of its announcement by the President of the Central Statistical Office in the Official Journal The Republic of Poland "Monitor Polski", advertised on the basis of art. 20 point 2 of the Act of 17 December 1998. o pensions from the Social Insurance Fund (Dz. U. 2009 r. No. 153, pos. 1227, of late. zm.). Where the amount of the benefit is a multiple of one month's salary as the basis for its determination (two-or three-month recovery; two-month compensation), the amount of the benefit may not exceed the appropriate amount multiples of the above average monthly salary from the previous quarter.

⁸⁾ To be completed taking into account art. 12 (1) 5 of the Act, which provides that allowances for unpaid repayments and compensation are met by the Fund when the termination of the employment relationship has occurred within a period of not more than 4 months following the date of the insolvency employers.

⁹⁾ Columns 1 to 17 of the supplementary list shall be completed by the operator referred to in point 1 of the explanatory notes. Prior to the submission of the supplementary list, the entity shall consult the Marshal of the voivodship of the applicable average monthly remuneration of the previous quarter, referred to in point 7 of the explanatory notes.

¹⁰⁾ Column 18 of the supplementary list shall be completed by the marshal of the voivodship, after having established that the total amount of the benefits payable by the Fund shown in column 17 was established in accordance with the provisions of the Act.

¹¹⁾ Columns 19 to 21 of the supplementary list shall be completed by the operator referred to in point 1 of the explanatory notes after having received two copies of the list referred to in paragraph 5 of the Regulation.

¹²⁾ In column 21, enter the amount equal to the difference between the amount in column 18 and the amount of the deductions from columns 19 and 20.

¹³⁾ Representation of the holder in accordance with the rules in force for the civil-law commitment.

Annex 3. [ MODEL-REQUEST FOR PAYMENT OF BENEFITS FROM THE EMPLOYEE BENEFIT GUARANTEE FUND FOR UNSATISFIED WORKERS ' CLAIMS]

Annex No 3

MODEL- APPLICATION FOR PAYMENT OF BENEFITS FROM THE EMPLOYEE BENEFIT GUARANTEE FUND FOR UNPAID EMPLOYEE CLAIMS