Reply to request for information

H002 - Reply to request for information
Article 76 of Regulation (EC) No 883/2004

SED API version: 0.15.3 build preview 1
Model version: 4.1.0

1. Reply to request for information *

Person*
Employer*
Reimbursement Bulk SED*

1.1.1. Person identification *

1.1.1.1. Person Identification *

1.1.1.1.1. Family name(s) *

1.1.1.1.2. Forename(s) *

1.1.1.1.3. Date of birth *

1.1.1.1.4. Sex *

1.1.1.1.5. Family name(s) at birth

1.1.1.1.6. Forename(s) at birth

1.1.1.1.7. PIN of the person in each institution

1.1.1.1.7.1. Personal Identification Number(s) *

1.1.1.1.7.1.1. Country *

1.1.1.1.7.1.2. Personal Identification Number (PIN) *

1.1.1.1.7.1.3. Sector

1.1.1.1.7.1.4. Institution

1.1.1.1.7.1.4.1. Institution ID *

1.1.1.1.7.1.4.2. Institution Name *

1.1.1.1.7.1.Personal Identification Number(s)

1.1.1.1.8. If PIN not provided for every institution, please provide

1.1.1.1.8.1. Place of birth

1.1.1.1.8.1.1. Town *

1.1.1.1.8.1.2. Region

1.1.1.1.8.1.3. Country *

1.1.1.1.8.2. Father's family name at birth

1.1.1.1.8.3. Forename of father

1.1.1.1.8.4. Mother's family name at birth

1.1.1.1.8.5. Forename of mother

1.1.1.2. Additional information on the person

1.1.1.2.1. Nationality

1.1.1.2.2. Status of the person

1.1.1.2.3. Please fill in if "Status of the person" = "Other":

1.1.1.2.3.1. Other

1.1.2. Address of the person

1.1.2.1. Address of the person

1.1.2.1.1. Type of Address

1.1.2.1.2. Address

1.1.2.1.2.1. Street

1.1.2.1.2.2. Building Name

1.1.2.1.2.3. Town *

1.1.2.1.2.4. Postal Code

1.1.2.1.2.5. Region

1.1.2.1.2.6. Country *

1.1.2.1.Address of the person

1.1.3. Information for identification of the person

1.1.3.1. Person

1.1.3.1.1. Family name(s)

1.1.3.1.2. Forename(s)

1.1.3.1.3. Birth date

1.1.3.1.4. Sex

1.1.3.1.5. Family name(s) at birth

1.1.3.1.6. Forename(s) at birth

1.1.3.1.7. Place of birth

1.1.3.1.7.1. Town *

1.1.3.1.7.2. Region

1.1.3.1.7.3. Country *

1.1.3.1.8. Father's family name at birth

1.1.3.1.9. Forename of father

1.1.3.1.10. Mother's family name at birth

1.1.3.1.11. Forename of mother

1.1.3.1.12. Previous family name(s)

1.1.3.1.13. Previous forename(s)

1.1.4. Sector PIN (Personal Identification Number of the sending institution)

1.1.4.1. Sector PIN (Personal Identification Number of the sending institution)

1.1.4.1.1. All

1.1.4.1.2. Sickness in cash

1.1.4.1.3. Sickness in kind

1.1.4.1.4. Pension

1.1.4.1.5. Unemployment

1.1.4.1.6. Occupational disease and accident at work, benefits in cash

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1.1.4.1.7. Occupational disease and accident at work, benefits in kind

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1.1.4.1.8. Family benefits

1.1.4.1.9. Recovery

1.1.4.1.10. National Tax number

1.1.4.1.11. Other sector PIN

1.1.4.2. Please fill in the following if "Sector PIN"="Other sector PIN":

1.1.4.2.1. Description of other sector

1.1.5. Positive reply to requested information

1.1.5.1. We are enclosing

1.1.5.1.1. The following document(s)

1.1.5.1.2. The following information

1.1.5.1.3. The following SED(s)

1.1.6. Negative reply to requested information

1.1.6.1. We are unable to send

1.1.6.1.1. The following document(s)

1.1.6.1.2. The following information

1.1.6.1.3. The following SED(s)

1.1.6.1.4. Reasons

1.1.6.1.We are unable to send

1.1.7. Additional information

1.1.7.1. Additional information

1.1.8. Please find attached the following documents:

1.1.8.1. Predefined Documents

1.1.8.2. Other Documents Attached

1.1.8.2.1. Other Document

1.1.8.2.1.1. Document

1.1.8.2.1.Other Document

1.2.1. Employer *

1.2.1.1. Name *

1.2.1.2. Identification numbers

1.2.1.2.1. Identification number

1.2.1.2.1.1. Number *

1.2.1.2.1.2. Type *

1.2.1.2.1.Identification number

1.2.1.3. Address

1.2.1.3.1. Street

1.2.1.3.2. Building Name

1.2.1.3.3. Town *

1.2.1.3.4. Postal Code

1.2.1.3.5. Region

1.2.1.3.6. Country *

1.2.2. Positive reply to requested information

1.2.2.1. We are enclosing

1.2.2.1.1. The following document(s)

1.2.2.1.2. The following information

1.2.2.1.3. The following SED(s)

1.2.3. Negative reply to requested information

1.2.3.1. We are unable to send

1.2.3.1.1. The following document(s)

1.2.3.1.2. The following information

1.2.3.1.3. The following SED(s)

1.2.3.1.4. Reasons

1.2.3.1.We are unable to send

1.2.4. Additional information

1.2.4.1. Additional information

1.2.5. Please find attached the following documents:

1.2.5.1. Predefined Documents

1.2.5.2. Other Documents Attached

1.2.5.2.1. Other Document

1.2.5.2.1.1. Document

1.2.5.2.1.Other Document

1.3.1. Reimbursement identification *

1.3.1.1. Reimbursement Request ID *

1.3.2. Positive reply to requested information

1.3.2.1. We are enclosing

1.3.2.1.1. The following document(s)

1.3.2.1.2. The following information

1.3.2.1.3. The following SED(s)

1.3.3. Negative reply to requested information

1.3.3.1. We are unable to send

1.3.3.1.1. The following document(s)

1.3.3.1.2. The following information

1.3.3.1.3. The following SED(s)

1.3.3.1.4. Reasons

1.3.3.1.We are unable to send

1.3.4. Additional information

1.3.4.1. Additional information

1.3.5. Please find attached the following documents:

1.3.5.1. Predefined Documents

1.3.5.2. Other Documents Attached

1.3.5.2.1. Other Document

1.3.5.2.1.1. Document

1.3.5.2.1.Other Document

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H002 - Reply to request for information Article 76 of Regulation (EC) No 883/2004

H002 - Reply to request for information
Article 76 of Regulation (EC) No 883/2004