Transfer of additional information

P10000 - Transfer of additional information
Articles 47(1)(4), 46(3), 48(2) of Regulation (EC) No 987/2009

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

1. Local case numbers

1.1. Local Case Number

1.1.1. Country *

1.1.2. Case number *

1.1.3. Institution

1.1.3.1. Institution ID *

1.1.3.2. Institution Name *

1.1.Local Case Number

2. Insured person *

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 the person

2.2.1. Additional information on the person

2.2.1.1. Nationality

2.2.1.2. Previous family name(s)

2.2.1.3. Previous forename(s)

2.2.2. Address

2.2.2.1. Street

2.2.2.2. Building Name

2.2.2.3. Town *

2.2.2.4. Postal Code

2.2.2.5. Region

2.2.2.6. Country *

2.2.3. Contact information on the person

2.2.3.1. Telephone Numbers

2.2.3.1.1. Telephone Number

2.2.3.1.1.1. Type

2.2.3.1.1.2. Number *

2.2.3.1.1.Telephone Number

2.2.3.2. Email Addresses

2.2.3.2.1. Email Address

2.2.3.2.1.1. Email Address

2.2.3.2.1.Email Address

3. Other person

3.1. Role of the person concerned

3.2. Person identification *

3.2.1. Family name(s) *

3.2.2. Forename(s) *

3.2.3. Date of birth *

3.2.4. Sex *

3.2.5. Family name(s) at birth

3.2.6. Forename(s) at birth

3.2.7. PIN of the person in each institution

3.2.7.1. Personal Identification Number(s) *

3.2.7.1.1. Country *

3.2.7.1.2. Personal Identification Number (PIN) *

3.2.7.1.3. Sector

3.2.7.1.4. Institution

3.2.7.1.4.1. Institution ID *

3.2.7.1.4.2. Institution Name *

3.2.7.1.Personal Identification Number(s)

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

3.2.8.1. Place of birth

3.2.8.1.1. Town *

3.2.8.1.2. Region

3.2.8.1.3. Country *

3.2.8.2. Father's family name at birth

3.2.8.3. Forename of father

3.2.8.4. Mother's family name at birth

3.2.8.5. Forename of mother

3.3. Additional information on the person

3.3.1. Additional information on the person

3.3.1.1. Nationality

3.3.1.2. Previous family name(s)

3.3.1.3. Previous forename(s)

3.3.2. Contact information on the person

3.3.2.1. Telephone Numbers

3.3.2.1.1. Telephone Number

3.3.2.1.1.1. Type

3.3.2.1.1.2. Number *

3.3.2.1.1.Telephone Number

3.3.2.2. Email Addresses

3.3.2.2.1. Email Address

3.3.2.2.1.1. Email Address

3.3.2.2.1.Email Address

4. Relationship of the Dependant / Family Member or child to the insured person

4.1. Relationship to the insured person

4.1.1. Relationship to the insured person

4.1.2. Please fill in the following if "Relationship to the insured person" = "Other relative" :

4.1.2.1. Description of other relative

5. Reference to the person

5.1. This information is given with reference to the person named in

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6. Transferring document(s)

6.1. Please find attached following document(s)

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6.2. Additional information on document(s)

7. Life/death information

7.1. According to our official sources

7.2. Date of death of the person

7.3. Place of birth

7.3.1. Address

7.3.1.1. Town *

7.3.1.2. Region

7.3.1.3. Country *

8. Information on attendance to school/training/higher studies

8.1. Attendance to school/training/higher studies

8.1.1. Start date of attendance to school/training/higher studies

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8.1.2. End date of attendance to school/training/higher studies

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8.1.3. Type of school/training/higher studies

8.1.4. Name of educational institution/school/university

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8.1.5. Detailed information on attendance to school/training/higher studies

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8.1.Attendance to school/training/higher studies

9. Current address of the person

9.1. Address

9.1.1. Street

9.1.2. Building Name

9.1.3. Town *

9.1.4. Postal Code

9.1.5. Region

9.1.6. Country *

9.2. Date of change of the address

10. Family Status

10.1. Family status

10.1.1. Family Status

10.1.2. Family status date

10.1.Family status

11. Information on the representative/legal guardian

11.1. Name

11.2. Grounds

11.3. Address

11.3.1. Street

11.3.2. Building Name

11.3.3. Town *

11.3.4. Postal Code

11.3.5. Region

11.3.6. Country *

12. Information on payment

12.1. Payment to

12.2. Bank information

12.2.1. Account holder name

SEPA Account*
Non-SEPA Account*

12.2.2.1. IBAN *

12.2.2.2. BIC-SWIFT

12.2.3.1. Account Number *

12.2.3.2. BIC-SWIFT

12.2.3.3. Bank Name *

12.2.3.4. Bank Address *

12.2.3.4.1. Street

12.2.3.4.2. Building Name

12.2.3.4.3. Town *

12.2.3.4.4. Postal Code

12.2.3.4.5. Region

12.2.3.4.6. Country *

13. Contact information of the person

13.1. Telephone number of the person

13.2. E-mail of the person

13.3. Address for correspondence

13.3.1. Address

13.3.1.1. Street

13.3.1.2. Building Name

13.3.1.3. Town *

13.3.1.4. Postal Code

13.3.1.5. Region

13.3.1.6. Country *

13.3.2. PO Box address

13.4. Contact person at the address

14. Information on person's benefit(s)

14.1. Person's benefit information

14.1.1. The person

14.1.2. The following benefit

14.1.3. Please fill in the following if "The following benefit " = "Other benefits" :

14.1.3.1. Other benefit(s)

14.1.4. Date of the claim for benefit

14.1.5. Start date of entitlement

14.1.6. End date of entitlement

14.1.7. Start date of payment

14.1.8. End date of payment

14.1.9. Start date of suspension of benefit

14.1.10. End date of suspension of benefit

14.1.11. Start date of reduction of benefit

14.1.12. End date of reduction of benefit

14.1.13. Amount

14.1.13.1. Amount

14.1.13.2. Currency

14.1.13.3. Amount effective since

14.1.13.4. Payment frequency

14.1.13.5. Please fill in the following if "Payment frequency" = "Other" :

14.1.13.5.1. Other payment frequency

14.1.13.Amount

14.1.14. Supplements and additional frequent payments to the pension

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14.1.15. Date of rejection of benefit

14.1.16. Other information on benefit(s)

14.1.Person's benefit information

15. Information on person's activity

15.1. Detailed information on activity

15.1.1. The person is/was running activity as

15.1.2. Start date of activity

15.1.3. End date of activity

15.1.4. Working hours per week

15.1.5. Occupation

15.1.Detailed information on activity

15.2. Information on Non-activity

15.2.1. The person is/was non-active

15.2.2. Start date

15.2.3. End date

15.2.Information on Non-activity

15.3. Information on Unemployment

15.3.1. The person is/was unemployed

15.3.2. Start date

15.3.3. End date

15.3.Information on Unemployment

15.4. Additional information on activity/non-activity

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16. Information on person's income

16.1. Person's income

16.1.1. The person

16.1.2. Source of income

16.1.3. Start date of receiving income

16.1.4. End date of receiving income

16.1.5. Amount

16.1.5.1. Amount

16.1.5.2. Currency

16.1.5.3. Amount effective since

16.1.5.4. Payment frequency

16.1.5.5. Please fill in the following if "Payment frequency" = "Other" :

16.1.5.5.1. Other payment frequency

16.1.5.Amount

16.1.6. Supplements and additional frequent payments to income

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16.1.7. Additional information on income

16.1.Person's income

17. Information on withdrawal of pension claim

17.1. The person has withdrawn pension claim under the legislation of following Member State

17.1.1. Country code

17.1.2. Date of withdrawal

17.1.3. Comments

17.1.The person has withdrawn pension claim under the legislation of following Member State

18. Claim for review according to Art. 48 (2) of Reg. (EC) No 987/2009

18.1. Date when the claim for review was submitted

18.2. See P7000 dated

18.3. The claim for review submitted by the person is attached

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19. Statement of the person

19.1. The person made and signed at our institution the following statement

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19.2. Date of the statement

20. Additional information

20.1. Additional information

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P10000 - Transfer of additional information Articles 47(1)(4), 46(3), 48(2) of Regulation (EC) No 987/2009

P10000 - Transfer of additional information
Articles 47(1)(4), 46(3), 48(2) of Regulation (EC) No 987/2009