Claim for Death Grant

M030 - Claim for Death Grant
Articles 42, 43 of Regulation (EC) No 883/04; Article 42 of Regulation (EC) No 987/09

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

1. Deceased person *

1.1. Deceased Person *

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 deceased person

1.2.1. Nationality

1.2.2. Previous name(s)

1.2.2.1. Previous family name(s)

1.2.2.2. Previous forename(s)

1.2.3. Address of the deceased person before death

1.2.3.1. Street

1.2.3.2. Building Name

1.2.3.3. Town *

1.2.3.4. Postal Code

1.2.3.5. Region

1.2.3.6. Country *

1.2.4. Status of the deceased person before death

1.2.5. Please fill in the following if "Status of the deceased person before death" = "Other"

1.2.5.1. Other status

1.2.6. Status

2. Claimant *

2.1. Person Identification

2.1.1. Family name(s) *

2.1.2. Forename(s) *

2.1.3. Date of birth *

2.1.4. Sex *

2.1.5. Family name(s) at birth

2.1.6. Forename(s) at birth

2.1.7. PIN of the person in each institution

2.1.7.1. Personal Identification Number(s) *

2.1.7.1.1. Country *

2.1.7.1.2. Personal Identification Number (PIN) *

2.1.7.1.3. Sector

2.1.7.1.4. Institution

2.1.7.1.4.1. Institution ID *

2.1.7.1.4.2. Institution Name *

2.1.7.1.Personal Identification Number(s)

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

2.1.8.1. Place of birth

2.1.8.1.1. Town *

2.1.8.1.2. Region

2.1.8.1.3. Country *

2.1.8.2. Father's family name at birth

2.1.8.3. Forename of father

2.1.8.4. Mother's family name at birth

2.1.8.5. Forename of mother

2.2. Additional information on claimant

2.2.1. Nationality

2.2.2. Previous name(s)

2.2.2.1. Previous family name(s)

2.2.2.2. Previous forename(s)

2.2.3. Status of the claimant

2.2.4. Please fill in the following if "Status of the claimant" = "Other"

2.2.4.1. Other status

2.2.5. Status

2.2.6. Relationship to the deceased person

2.2.6.1. Relationship to the deceased person

2.2.6.2. Please fill in the following if "Relationship to the deceased person" = "Other" :

2.2.6.2.1. Other relationship

2.2.6.3. The deceased person was dependant of the claimant

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2.2.6.4. The claimant was dependant of the deceased person

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2.3. Other Claimant

2.3.1. If the claimant is

2.3.2. Please fill in:

2.3.2.1. Name of legal person/undertaker

2.3.2.2. Identification of legal person/undertaker

2.3.2.2.1. Registration number

2.3.2.2.2. Social security number

2.3.2.2.3. Fiscal number

2.3.3. Name of person entitled to represent legal person/undertaker

2.3.3.1. Family name(s)

2.3.3.2. Forename(s)

2.4. Address

2.4.1. Street

2.4.2. Building Name

2.4.3. Town *

2.4.4. Postal Code

2.4.5. Region

2.4.6. Country *

3. Additional information on the claim for death grant *

3.1. Details of Death *

3.1.1. Death date of the deceased person *

3.1.2. Place of death

3.2. Date of the claim *

3.3. Legislation of sending institution *

3.4. The Claimant *

3.5. The Claimant

4. Information on representative/legal guardian

4.1. Status

4.2. Information on the representative/legal guardian

4.2.1. Name

4.2.2. Address

4.2.2.1. Street

4.2.2.2. Building Name

4.2.2.3. Town *

4.2.2.4. Postal Code

4.2.2.5. Region

4.2.2.6. Country *

5. Information on payment *

5.1. Payment to *

5.2. Bank details

SEPA account*
Non-SEPA account*

5.2.1.1. IBAN *

5.2.1.2. BIC-SWIFT

5.2.2.1. Account number *

5.2.2.2. BIC-SWIFT *

5.2.2.3. Bank Name *

5.2.2.4. Bank Address *

5.2.2.4.1. Street

5.2.2.4.2. Building Name

5.2.2.4.3. Town *

5.2.2.4.4. Postal Code

5.2.2.4.5. Region

5.2.2.4.6. Country *

6. Additional Information

6.1. Additional Information

7. Please find attached following document(s)

7.1. Attached document(s)

7.2. Other document(s)

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M030 - Claim for Death Grant Articles 42, 43 of Regulation (EC) No 883/04; Article 42 of Regulation (EC) No 987/09

M030 - Claim for Death Grant
Articles 42, 43 of Regulation (EC) No 883/04; Article 42 of Regulation (EC) No 987/09