Reply to proposal on State of Residence/Disagreement with decision on State of Residence

H004 - Reply to proposal on State of Residence/Disagreement with decision on State of Residence
Article 76 of Regulation (EC) No 883/2004; Article 11 of Regulation (EC) No 987/2009

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

1. Person *

1.1. Person identification *

1.1.1. Family name(s) *

1.1.2. Forename(s) *

1.1.3. Date of birth *

1.1.4. Sex *

1.1.5. Family name(s) at birth

1.1.6. Forename(s) at birth

1.1.7. PIN of the person in each institution

1.1.7.1. Personal Identification Number(s) *

1.1.7.1.1. Country *

1.1.7.1.2. Personal Identification Number (PIN) *

1.1.7.1.3. Sector

1.1.7.1.4. Institution

1.1.7.1.4.1. Institution ID *

1.1.7.1.4.2. Institution Name *

1.1.7.1.Personal Identification Number(s)

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

1.1.8.1. Place of birth

1.1.8.1.1. Town *

1.1.8.1.2. Region

1.1.8.1.3. Country *

1.1.8.2. Father's family name at birth

1.1.8.3. Forename of father

1.1.8.4. Mother's family name at birth

1.1.8.5. Forename of mother

1.2. Additional information on the person

1.2.1. Nationality

2. Address of the person

2.1. Address of the person

2.1.1. Type of Address

2.1.2. Address

2.1.2.1. Street

2.1.2.2. Building Name

2.1.2.3. Town *

2.1.2.4. Postal Code

2.1.2.5. Region

2.1.2.6. Country *

2.1.Address of the person

3. Reply to proposal on state of residence *

3.1. Reply *

3.2. Please fill in the following if "Reply" = "Reject proposal with new proposal" :

3.2.1. Reject proposal

3.2.1.1. Reasoning of rejection

3.2.1.2. New proposed State of Residence

3.2.1.3. Starting date

4. Disagreement with decision on residence

4.1. Date of your decision

4.2. Justification

5. Additional information

5.1. Additional information

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H004 - Reply to proposal on State of Residence/Disagreement with decision on State of Residence Article 76 of Regulation (EC) No 883/2004; Article 11 of Regulation (EC) No 987/2009

H004 - Reply to proposal on State of Residence/Disagreement with decision on State of Residence
Article 76 of Regulation (EC) No 883/2004; Article 11 of Regulation (EC) No 987/2009