Advise inquirers that when writing to obtain a certificate of coverage, they should provide the following information:

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  full name;

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  Social Security number (U.S. number for U.S. certificate and Dutch number for Dutch certificate);

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  country of citizenship;

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  date and place of birth;

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  country of permanent residence;

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  name and address of employer in both countries (if self-employed, address of trade or business in both countries);

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  date and place of hire by sending company, if employed; and

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  beginning date and ending date (if known) of employment or self-employment in the other country.

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  Spouse's name (including maiden name)

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  Spouse's date of birth (MM,DD,YY)

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  Children's names

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  Children's dates of birth (MM,DD,YY)

NOTE: If the worker will be an employee of a Dutch affiliate of an American employer, the request must indicate whether the American employer has entered into an agreement with the Internal Revenue Service under Section 3121(l) of the Internal Revenue Code and, if so, the effective date of such an agreement.

NOTE: The Office of Earnings and International Operations (OEIO), Division of Training and Program Support (DTPS), International Support Branch (ISB) will show the name of an unmarried ("domestic") partner as a family member on a certificate when the partner will accompany the worker to the Netherlands.

OEIO or the Dutch authority takes the following steps to issue a certificate of coverage:

1. The employee, employer (in the case of employment), or the worker (in the case of self-employment) writes to the appropriate authority requesting a certificate.

Note: For requests for U.S. certificates of coverage, the employer’s representative (attorney, accounting firm, employer services firm, etc.) or worker's representative may request the certificate on the employer's or worker's behalf. If an employee requests the certificate, OEIO will need to contact the employer to confirm the accuracy of the information provided.

2. The United States or Netherlands issues the certificate, if appropriate.

3. The issuing agency sends the original and one copy to the requester.

4. The employer, employee, or worker presents the certificate to the tax authorities in the other country upon request.

5. If the worker is a self-employed U.S. citizen or national who is subject only to Dutch laws under the agreement, the self-employed worker must attach a photocopy of the Dutch certificate of coverage to the Schedule SE filed with the U.S. income tax return each year.