APPLICATION FORM SNA

APPLICATION FORM
SNA-KEURMERK
This section will be completed by the Dutch Labour Standards Foundation (Stichting Normering Arbeid)
Registratienummer onderneming
Opname Register
Nummer contactpersoon
Opname Overzicht aangemelde ond.
Volmacht aanwezig
Recent Bedrijfprofiel KvK aanwezig
Return to:
Stichting Normering Arbeid | Postbus 90154 | 5000 LG Tilburg
E-mail: [email protected] | I.: www.normeringarbeid.nl | Fax: 013 - 5944748
Stichting Normering Arbeid
June 2016
Company data
Company name
(legal name)
Visiting address
Postal code
City
P.O. Box
Postal code
City
Country
Telephone number
Fax number
Email address
Internet
Data contact person
Surname
Initials
Title(s)
Function
Telephone number
Email address
Data owner
(Sur)name
Initials *
City
Country
* if applicable
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Specific data
Number Chamber of Commerce
Country of origin (abstract < 3 months old)
Number Dutch Chamber of Commerce*
(abstract < 3 months old)
SBI-code(s) Dutch Chamber of Commerce*
* Dutch Chamber of Commerce for Dutch companies or if a foreign company deploys staff in the Netherlands
Legal entity (e.g. Ltd, GmbH, SA)
Number of branches *
* if applicable: please provide us with the address(es) of the branch(es) on a seperate form
Statutory payroll tax numbers / sub no.
VAT number / sub no.
Number fiscal unity
(if applicable)
Administration office (name / city)
(if applicable)
Member association (name)
The inspections are performed by:
Bureau Cicero 1)
FlexSpect 1), 2)
The Auditing Company 1)
Cetradex Inspectie BV 1)
Kiwa Nederland 1)
VRO Certification 1)
CLIB 2)
Qualitatis Inspectie BV 1)
CROP certificering BV 1)
Safex Inspectie Instelling BV
1), 2)
1) Performs NEN 4400-1 inspections (Dutch companies)
2) Performs NEN 4400-2 inspections (Foreign companies)
Company is active in the field of:
Temporary work business
Contracting / subcontracting
Sectors in which the company is active (more than one sector possible):
General
Technical
Medical
Agricultural
Administrative
Meat
Construction
Industrial
Poultry
Cleaning
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Company whishes to have inspections performed on the basis of:
NEN 4400-1 (Dutch companies)
NEN 4400-2 (Foreign companies)
Undersigned requests the board of the Dutch Labour Standards Foundation (Stichting Normering Arbeid) to be
entered into the Labour Standards Register of the Dutch Labour Standards Foundation (Stichting Normering
Arbeid), after the assigned inspection body has performed a positive conformity assessment (inspection) on the
basis of NEN 4400-1 / -2.
Undersigned is aware that the company, as long as it does not possess a positive inspection result based on
NEN 4400-1 / -2 granted by an inspection body that has been accredited by the Dutch Accreditation Council
(Raad voor Accreditatie) and has a cooperation agreement with the Dutch Labour Standards Foundation
(Stichting Normering Arbeid), will be listed in the "List of Notified Companies". Listing in the "List of Notified
Companies" is possible for a maximum period of 3 months.
Undersigned will not be granted any rights to the filed application for registration and certification, as long as no
official notice of the Dutch Labour Standards Foundation (Stichting Normering Arbeid) has been received. By
placing your signature you are confirming to subject to the statutes and regulations of the Dutch Labour
Standards Foundation (Stichting Normering Arbeid). Furthermore you are giving the Dutch Labour Standards
Foundation (Stichting Normering Arbeid) permission to verify the data provided by you and you are declaring to
pay the due contributions after receipt of the invoice within 14 days.
Granting a power of attorney for statements concerning tax declarations and payments of due income taxes
and sales taxes is a part of the registration procedure. The signed power of attorney and a recent (not older
than trhee months) Company Profile from the Chamber of Commerce and the address(es) of branch(es)
should be returned together with the application form.
I declare to have filled out this form in honour and conscience, clearly, genuinely and unconditionally I declare
to have taken knowledge of the rules of registration and agree with the provisions contained therein.
Name
Date
Signature
Attachments:
Power of Attorney
Company Profile from the (Dutch*) Chamber of Commerce (not older than 3 months)
Address(es) branch(es)
* Dutch Chamber of Commerce for Dutch companies or if a foreign company deploys staff in the Netherlands
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POWER OF ATTORNEY
For statements concerning tax declarations and payments of due
statutory payroll taxes and VAT
Herewith declares
Company name
Located in
Statutory payroll tax no.*
VAT no.*
* including sub-numbers!
Number fiscal unity*
* if applicable
to grant the power of attorney to the Dutch Labour Standards Foundation (Stichting Normering Arbeid), located
in Tilburg, to periodically request the recipient of the Tax Department for a statement concerning the tax
declarations and payments of the due statutory payroll taxes and VAT by
(company name) and to take notice of this statement. It concerns a request in the sense of article 67, lid 2,
letter c General Law on the subject of Government taxes (Algemene Wet inzake Rijksbelastingen).
This power of attorney is valid in the period during which the company is listed in the registry of the
aforementioned Dutch Labour Standards Foundation (Stichting Normering Arbeid), unless the grantor of the
power of attorney revokes this power of attorney on an earlier date.
The grantor of the power of attorney agrees that the aforementioned Dutch Labour Standards Foundation
(Stichting Normering Arbeid) will inform the Tax Department B/CA about the end of registration and declares to
be responsible himself for revoking the power of attorney on an earlier date. The grantor of the power of
attorney who revokes the power of attorney on an earlier date does so by sending a notification in writing to the
Dutch Labour Standards Foundation (Stichting Normering Arbeid) and a copy at the same time to the Tax
Department: Belastingdienst Centrale Administratie, attn. Bedrijfsbureau C.I.V. Kamer 2.48, Postbus 9053,
7300 GR Apeldoorn.
Grantor of power of attorney,
Signature
Company director:
city and date:
Return to:
Stichting Normering Arbeid | Postbus 90154 | 5000 LG Tilburg
E-mail: [email protected] | I.: www.normeringarbeid.nl | Fax: 013 - 5944748
Page 5 / 8
Form Collective Labour Agreement, Pension and Social Fund
1. Company data
Company name
(legal name)
Visiting address
Postal code
City
P.O. box
Postal code
City
2. Data contact person
Surname
Initials
Function
3. Data concerning Collective Labour agreement (CAO) / Pension / Social Fund
3.1 CAO applies
(tick as appropriate)
3.2 Participation in a
pension fund
Yes, name CAO:
No
Yes
proceed to question 3.3
No
proceed to question 3.4
(tick as applicable)
Exemption obtained (add copy)
3.3 Name pension fund
Account number
Account number
Account number
Stichting Normering Arbeid
June 2016
3.4 Participation in a
social fund
Yes
proceed to question 3.5
No
proceed to question 4
(tick as applicable)
Exemption obtained (add copy)
3.5 Name social fund
Account number
4. Specific data
When you ticked "No" on either question 3.1, 3.2 or 3.4 you need to answer question 4.1 to 4.6.
4.1 Does the company provide workers for the purpose of working under the supervision or direction of a
third party? (tick as applicable)
Yes
No
4.2 Is there any contracting work performed, where the staff of the company operates under its own direction
and supervision? (tick as applicable)
Yes
No
4.3 When you ticked "No" on question 4.1 and 4.2, give a description of the work carried out by the company:
4.4 In which sector (s) is the company classified according to the tax authorities (Belastingdienst)?
4.5 What type of work do the workers / employees perform?
4.6 Fill in the two sectors in which the company operates most and the total payroll percentage of the workers /
employees that are active in these sectors.
Sector
Payroll percentage
Sector
Payroll percentage
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Signing
By signing this form you agree:
- to have answered all the questions correctly, to your best knowledge, and in accordance with the truth;
- to give SNA permisson to use the provided information (including any accompanying documents and other
available information regarding the company);
- to inmediatly correspond any changes to the provided information to your inspection body by sending them a
newly completed form.
Name
Function
Date
Signature
We ask you to send a completed and sigend form to the inspection body with whom you have a contract.
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