Forms
- Certificate of living (PDF 37,6 kB)
- Annex to Request for Exception from Application of the Czech Social Security Legislation pursuant to Article 16 of EP and Council Regulation (EC) 883/2004 and Article 17 of Council Regulation (EEC) 1408/71 (DOC 77,5 kB)
- Affirmation for foreign employers (PDF 29,8 kB)
Other forms – Certificate of living
- Bulgarian (PDF 51,62 kB)
- Italian (PDF 37,34 kB)
- Japanese (PDF 91,85 kB)
- Korean (DOC 107,5 kB)
- Polish (PDF 42,89 kB)
- Russian (PDF 54,4 kB)
- Spanish (PDF 38 kB)
- Ukrainian (DOC 72 kB)
Bilateral Agreements
Application for the Czech pension for persons residing in contracting state
- Albania
- Australia
- Canada
- India
- Israel
- Japan
- Korea
- Moldova
- Québec
- Russia
- Tunisia
- USA
Application for persons residing in the Czech Republic for pension from contracting state
- Albania
- Australia
- Canada
- India
- Israel
- Japan
- Korea
- Moldova
- Québec
- Russia
- Tunisia
- USA
Application for Czech pension for persons residing in contracting state |
ALBANIAForm AL/CZ 202 (PDF 155,27 kB) Please, send the form filled-in with block letters or electronically to the below-mentioned institution or its regional office depending on your place of residence: Instituti i Sigurimeve Shoqërore (Social Insurance Institute) Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the CSSA. |
AUSTRALIAPlease, send the form filled-in with block letters or electronically to the below-mentioned institution or its regional office depending on your place of residence: Centrelink International Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the CSSA. |
CANADAForm CAN-CZ 1 (PDF 86,13 kB) (czech-french version) Please fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: International Operations – AB fax: +1-780-495-5753 Where appropriate the institution will contact you for any missing information or documentation.Once your application is complete, it will be forwarded it to CSSA. |
INDIAForm CZ/IN 202 (PDF 692,67 kB) Please, send the form filled-in with block letters to your (last) employer who shall forward it to the EPFO (Indian Employees Provident Fund Organisation). Where appropriate you might be contacted for any missing information or documentation. |
ISRAELPlease fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: |
JAPANPlease fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the CSSA. |
KOREAPlease fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: |
MOLDOVAPlease, send the form filled-in with block letters or electronically to the below-mentioned institution or its regional office depending on your place of residence: Casa Naţională de Asigurări Sociale http://www.cnas.md/index.php?l=ro Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the CSSA. |
QUÉBECPlease fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: Where appropriate the institution will contact you for any missing information or documentation.Once your application is complete, it will be forwarded it to CSSA. |
RUSSIAForm CZ/RU 202/3.1 (PDF 244,39 kB) Pension Fund of Russian Federation
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TUNISIAPlease, send the form filled-in with block letters or electronically to the competent below-mentioned institution or its regional office depending on your place of residence: La Caisse Nationale de Sécurité Sociale Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the CSSA. |
USAForm CZ/USA 202 (DOC 229,5 kB) Send the form filled-in with block letters or electronically to the below-mentioned institution or its regional office depending on your place of residence:
The American party will consequently send your application for Czech pension benefits along with the proof of your insurance periods in the USA to the Czech Social Security Administration to Prague. If necessary, the Administration will ask you to provide more information. |
Application for persons residing in Czech Republic for pension from contracting state
ALBANIAForm CZ/AL 202 (PDF 151,7 kB) - Claim for a pension from Albania Please, fill-in the form „Claim for a pension from Albania“ with block letters or electronically and if necessary attach also the filled-in form „Request for certification of insurance periods in Albania” to it. Post the completed forms and any supporting documentation to the respective office of the Regional Social Security Administration or to the Prague Social Security Administration (if you live in Prague). This institution will forward your application for Albanian pension to ČSSZ The Czech Social Security Administration will attach the proof of your insurance periods in the Czech Republic and after filling-in any other necessary information all documents will be sent to the Social Insurance Institute in Albania. |
AUSTRALIAForm AUS140CZ_1107 (PDF 254,15 kB)Please, fill-in the form „Claim for Australian Age Pension under the Agreement between Australia and the Czech Republic on Social Security“ with block letters or electronically and attach also the filled-in supplement ”Income and Assets (PDF 193,82 kB)” to it. Both forms must be completed and signed by your partner too (if you have one). Post your completed forms and any supporting documentation to the respective office of the Regional Social Security Administration or to the Prague Social Security Administration (if you live in Prague). This institution will forward your application for Australian age pension to ČSSZ ČSSZ (Czech Social Security Administration) will attach the proof of your insurance periods in the Czech Republic and after filling-in any other necessary information all documents will be sent to the Australian institution Centrelink. Centrelink can contact you (in writing, by telephone or e-mail) in case it will be necessary to provide more details or some other information. |
CANADAForm GE-CAN (PDF 64,68 kB) (Czech-English version) Please fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: ČSSZ Praha Křížová 25 225 08 Praha 5 Tel.: 00420 257 061 111 E –mail: posta@cssz.cz Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the Canadian Institution for social security. |
INDIAForm IN/CZ 4 (PDF 561,72 kB) |
IZRAELForm – Claim for the old-age pension (PDF 707,85 kB) Please fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: |
JAPANPlease fill in the application and return it to the institution mentioned below or to its nearest local office to the following address:ČSSZ Praha Křížová 25 225 08 Praha 5 Tel.: 00420 257 061 111 E –mail: posta@cssz.cz Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the Japanese institution for social security. |
KOREAPlease fill in the application and return it to the institution mentioned below or to its nearest local office to the following address: |
MOLDOVAPlease, fill-in the form „Claim for a pension from Moldova“ with block letters or electronically. Post the completed form and any supporting documentation to the respective office of the Regional Social Security Administration or to the Prague Social Security Administration (if you live in Prague). This institution will forward your application for Moldovan pension to ČSSZ The Czech Social Security Administration will attach the proof of your insurance periods in the Czech Republic and after filling-in any other necessary information all documents will be sent to the institution for social security in Moldova. |
QUÉBECPlease fill in the application designated for Canada and return it to the institution mentioned below or to its nearest local office to the following address:ČSSZ Praha Křížová 25 225 08 Praha 5 Tel.: 00420 257 061 111 E –mail: posta@cssz.cz Where appropriate the institution will contact you for any missing information or documentation. Once your application is complete, it will be forwarded it to the institution for social security in Québec. |
RUSSIAForm RU 3/CZ 202 (PDF 221,47 kB) Fill in the form with block letters. Hand in the filled-in form at the respective office of the Regional Social Security Administration or in Prague at the Prague Social Security Administration or in Brno at Municipal Social Security Administration. This institution will forward your application for pension benefits to: The Czech Social Security Administration will attach the proof of your insurance periods completed in the Czech Republic and after filling-in any other necessary information, all documents will be sent to the Pension Fund of Russian Federation. |
TUNISIAForm CZ/TN 202 (PDF 255,49 kB) - Claim for a pension from Tunisia Please, fill-in the form „Claim for a pension from Tunisia“ with block letters or electronically and if necessary attach also the filled-in form „Declaration regarding the history of insurance periods ” to it. Post the completed forms and any supporting documentation to the respective office of the Regional Social Security Administration or to the Prague Social Security Administration (if you live in Prague). This institution will forward your application for Tunisian pension to ČSSZ The Czech Social Security Administration will attach the proof of your insurance periods in the Czech Republic and after filling-in any other necessary information all documents will be sent to the competent social security institution in Tunisia. |
USAForm SSA 2490 –BK (PDF 70,66 kB) Please, fill-in the form Application for Benefits under a U.S. Agreement with block letters or electronically and attach also the filled-in supplement ”Supplement to Claim for U.S. Benefit (WZ0-CZ-01 (DOC 143 kB)) (DOC 143 kB)” to it. Please, do not fill-in the Czech translation of Form SSA 2490 –BK, since it shall only make understanding of the original English form SSA 2490 –BK easier for you. Hand in the filled-in forms at the respective office of the Regional Social Security Administration or in Prague at the Prague Social Security Administration. This institution will forward your application for pension benefits to ČSSZ ČSSZ (Czech Social Security Administration) will attach the proof of your insurance periods in the Czech Republic and after filling-in any other necessary information all documents will be sent to the American insurance institution. The American insurance institution or its contact office for the central Europe in Warsaw (Federal Benefits Unit Warsaw) can contact you (in writing, by telephone or e-mail) in case it will be necessary to provide more details or some other information. |
Last update: 14. 7. 2022