This form is provided by the competent Member State at the request of the employer or the person concerned and establishes the presumption that the holder is properly affiliated to the social security system of the Member State that has issued the certificate.
Este formulario lo facilita el Estado miembro competente a petición del empleador o de la persona interesada y establece la presunción de que el titular está debidamente afiliado al sistema de seguridad social del Estado miembro que ha emitido el certificado.