Templates to copy

[Employer name], [address], RCS number [number]

CERTIFICATE

We hereby certify that [First name Last name], born on [date], residing at [address in the country of residence], has been employed by our company as [job title] since [start date], under a [permanent / fixed-term] contract, at [100 / …] % of full time.

The usual place of work is located at [address in Luxembourg].

For the calendar year [year], the number of working days spent wholly or partly outside Luxembourg was [number] days, of which:
- [number] days of telework in the country of residence;
- [number] days of business travel or training outside Luxembourg.

The total number of days actually worked in the year was [number]. A detailed list of the days is attached to this certificate.

Issued in [place] on [date], for whatever purpose it may serve.

[Name and title of signatory], [signature]

ADDENDUM TO THE EMPLOYMENT CONTRACT OF [date] — REGULAR TELEWORK

Between [employer], represented by [name], and [employee], the following is agreed, in accordance with the agreement on the legal framework for telework of 20 October 2020, declared generally binding by Grand-Ducal regulation of 22 January 2021.

1. Place: telework is carried out at [address] or [other place / arrangements for choosing the place].
2. Days and hours: [number] day(s) per week, on [day(s)], from [time] to [time]. Hours of availability: [hours].
3. Equipment: the employer provides [laptop, telephone, VPN access…] and maintains it.
4. Costs: the employer pays a monthly flat rate of €[amount] for connection and communication costs.
5. Benefits in kind: [any compensation for benefits linked to presence at the workplace, or: not applicable].
6. Disconnection: the company’s right-to-disconnect scheme applies to telework.
7. Data: the employee follows the internal data protection and IT security rules.
8. Return to the office: either party may end regular telework by giving [period] notice, without this constituting a change to the contract.
9. Tax and social security thresholds: the parties keep a record of the days worked outside Luxembourg in order to comply with the thresholds applicable to the employee’s country of residence.

Signed in duplicate in [place] on [date].

[Employer signature]          [Employee signature]

[First name Last name], [job title], [department]

To [head of administration], [administration]
Copy: [line manager]

Subject: application for authorisation to telework

Dear Sir or Madam,

I am applying for authorisation to carry out part of my duties by telework, on the following terms:
- share: [number] % of my workload (60 % at most);
- distribution: [days or hours, per week or as an average over the period];
- place: [address]; I can reach my place of work at very short notice if the service requires it;
- requested start date: [date].

My tasks are suited to telework for the following reasons: [description]. I have a suitable connection and will comply with the rules on confidentiality and working-time recording.

[If you are a cross-border worker:] As I live in [country], I will keep a record of my days in order to comply with the 34-day tax threshold and the social security limit.

Yours faithfully,

[Place, date, signature]

Record of days worked outside Luxembourg — year [year]
Name: [First name Last name] — Employer: [employer] — Country of residence: [country]

Date | Place | Country | Type (telework / business trip / training) | Approximate duration
[dd.mm.yyyy] | [town] | [FR / BE / DE / other] | [type] | [hours]

Total days outside Luxembourg: [number]
Total days worked in the year: [number]

[Place, date, signature]