Termination of insurance agreement Non-Swedish companies with temporary operations in Sweden Fora AB, SE-101 56 Stockholm, Sweden Agreement no. www.fora.se Telephone: + 46 8 787 40 10 Visitor address: Vasagatan 12 CIN: 556541-8356 Employer Fill in name and adress below Please send the form to: Fora AB, SE-101 56 Stockholm or fax to +46 8 787 40 90 The insurance agreement may not be terminated as long as there are employees still covered by collective agreements. We recommend that you maintain insurance coverage even if the company operates without employees, since self-employed persons and their spouses/registered partners who are active in the business are covered by Work Injury Insurance (TFA). If you have taken out ”Insurance for the self-employed” and want this to remain valid, your agreement for collective employee insurance must also remain in force. In the event that there are no employees, the agreement for collective employee insurance currently costs SEK 450 per calendar year. The undersigned employer hereby terminates the insurance agreement for collective insurance Reason Operations in Sweden have ceased Date No employees End date of last employment Other reason State reason and date for termination of the insurance agreement Other information Signature AP06 1308 Date Name (printed) Authorised signatory Contact E-mail address Telephone no. (with country and area code.)