BASIC (11-96)

GN 01728.105 Portuguese Coverage Certification

A. Policy

Portuguese coverage is certified on thebilingual Form P/USA 5. Coverage certifications are issued by the office with jurisdiction, either the NCP or Nucleo Coord. de Prest. Diferidas. Coverage certifications sent to OIO by either of the Portuguese agencies contain a complete record of an individual's work in Portugal.

B. Description of form P/USA 5

The form is divided into three sections. The following is a description of each section.

1. Identifying Information

The first section contains information needed to identify the worker (name, date of birth, address and U.S. and Portuguese Social Security numbers).

2. Periods of Insurance

This section contains periods of Portuguese coverage.

  • The first six columns show the “FROM - TO” dates of each period of coverage. The dates are shown in day/month/year format.

  • The total number of months for each period is shown in the last column.

  • The total number of months for all periods of coverage is shown under the last column.

3. Portuguese Agency Certification

The last section of the form contains the stamp of the agency that issued the coverage certification, the signature of the authorizing individual and the date.

C. Exhibit



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GN 01728.105 - Portuguese Coverage Certification - 04/10/2014
Batch run: 04/10/2014