PENSIONSVERSICHERUNGS ANST AL T
Landesstelle Wien
Friedrich-Hillegeist-Straße 1
A-1021 Wien
WWW.PENSIONSVERSICHERUNG.AT
Telefon: 050303
Telefax: +43(0)50303-29290
Ausland: +43/50303
PVA-LSW@PVA.SOZVERS.AT
APPLICATION FOR DIRECT TRANSFER OF AN AUSTRIAN PENSION TO ABROAD
1. First and surname of the eligible person
Date of birth
Social security
number
ZIP-Code
City, Country
Street, Number
2. To be completed if the receiver of payment is the guardian or the legal representative of the eligible person.
First and surname of the receiver
ZIP-Code
City, Country
Street, Number
3. I apply for the remittance of the pension payments
Holder of the account (first and surname)
monthly
quarterly
to following account:
Account number
Financial institution (full name and adress)
Banksorting code
Swift code
Direct transfer can only start after we have received complete and correct data.
4.
I declare that said account is under my sole disposal and that I will not authorise another person to
dispose of my account.
I oblige myself to report any changes in my personal circumstances which would have consequences on
the payments or the eligibility itself immediately and to pay back any overpayments to the Pensionsversicherungsanstalt der Angestellten. To accomplish this I instruct my financial institution with I hold my
account to remit – with effect even to my heirs – any overpayments to the Pensionsversicherungsanstalt
der Angestellten as long as the balance of the account is sufficient.
Herewith I authorise my financial institution to give any information relating to my pension or the remittance
of my pension to the Pensionsversicherungsanstalt der Angestellten.
....................................................................
Place
DVR: 2108296
Date
...........................................................................
Signature of the receiver
5. Confirmation of financial institution:
We take note of the application and confirm the statements made in section 3:
....................................................................
Place
Date
...........................................................................
Signature / stamp of financial institution
Seite 2/2