Form CPT165 "Certificate of Coverage Under the Canada Pension Plan Pursuant to Article 6 Paragraph (2) and Articles 7, 8 and 10 of the Social Security Agreement Between Canada and Romania" - Canada (English/French)
Form CPT165 "Certificate of Coverage Under the Canada Pension Plan Pursuant to Article 6 Paragraph (2) and Articles 7, 8 and 10 of the Social Security Agreement Between Canada and Romania" - Canada (English/French)
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Download Form CPT165 "Certificate of Coverage Under the Canada Pension Plan Pursuant to Article 6 Paragraph (2) and Articles 7, 8 and 10 of the Social Security Agreement Between Canada and Romania" - Canada (English/French)
Employed person – Travailleur salarié – Muncitor angajat
Self-employed person – Travailleur autonome – Muncitor independent
Name of worker – Nom du travailleur – Numele muncitorului
Canadian social insurance number – Numéro d'assurance sociale au Canada –
Num rul de asigurare social din Canada
Address – Adresse – Adresa
Date of birth – Date de naissance – Data naşterii
Citizenship – Nationalité – Cetăţenia
Name of employer in Canada – Nom de l'employeur au Canada – Numele
Date of hire – Date d'embauche – Data angajării
angajatorului din Canada
Business number in Canada – Numéro d'entreprise au Canada – Numărul firmei din
Canada
R P
Address in Canada – Adresse au Canada – Adresa din Canada
Name and address of the business where the worker will be working in the foreign country – Nom et adresse de l'entreprise où le travailleur travaillera dans le pays étranger
– Numele si adresa firmei la care muncitorul va lucra in străinătate
Print name and title of authorized officer – Nom et titre de la personne autorisée
Signature of authorized officer – Signature de la personne autorisée –
en lettres moulées – Tipăriți numele și titlul ofițerului/persoanei autorizat(e)
Semnătura persoanei autorizate
Telephone – Téléphone – Telefon
Date – Data
CPT165 E (18)
Protected B / Protégé B
when completed / une fois rempli
Certificate of Coverage Under the
Certificat d’assujettissement au
Certificat de atestare a contribu iei la
Canada Pension Plan Pursuant to
régime de pensions du Canada en
regimul de pensii din Canada în
Article 6 Paragraph (2) and Articles
vertu de l’article 6 paragraphe 2 et
conformitate cu articolele 6, alineat
7, 8 and 10 of the Social Security
des articles 7, 8 et 10 de l’accord de
(2) i cu articolele 7, 8 i 10 din
Agreement Between Canada and
sécurité sociale entre le Canada et la
acordul Româno-Canadian de
Romania
Roumanie
securitate social
Employed person – Travailleur salarié – Muncitor angajat
Self-employed person – Travailleur autonome – Muncitor independent
Name of worker – Nom du travailleur – Numele muncitorului
Canadian social insurance number – Numéro d'assurance sociale au Canada –
Num rul de asigurare social din Canada
Address – Adresse – Adresa
Date of birth – Date de naissance – Data naşterii
Citizenship – Nationalité – Cetăţenia
Name of employer in Canada – Nom de l'employeur au Canada – Numele
Date of hire – Date d'embauche – Data angajării
angajatorului din Canada
Business number in Canada – Numéro d'entreprise au Canada – Numărul firmei din
Canada
R P
Address in Canada – Adresse au Canada – Adresa din Canada
Name and address of the business where the worker will be working in the foreign country – Nom et adresse de l'entreprise où le travailleur travaillera dans le pays étranger
– Numele si adresa firmei la care muncitorul va lucra in străinătate
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