P3000_CZ - Country specific information - Czech Republic
Articles 45(4), 46(1), 47(4-5) 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
*
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1.1.2. Case number
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1.1.3. Institution
1.1.3.1. Institution ID
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1.1.3.2. Institution Name
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2. Insured person
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2.1. Person identification
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2.1.1. Family name(s)
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2.1.2. Forename(s)
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2.1.3. Date of birth
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2.1.4. Sex
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2.1.5. Family name(s) at birth
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2.1.6. Forename(s) at birth
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2.1.7. PIN of the person in each institution
2.1.7.1. Personal Identification Number(s)
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2.1.7.1.1. Country
*
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2.1.7.1.2. Personal Identification Number (PIN)
*
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2.1.7.1.3. Sector
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2.1.7.1.4. Institution
2.1.7.1.4.1. Institution ID
*
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2.1.7.1.4.2. Institution Name
*
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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
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2.1.8.1.2. Region
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2.1.8.1.3. Country
*
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2.1.8.2. Father's family name at birth
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2.1.8.3. Forename of father
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2.1.8.4. Mother's family name at birth
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2.1.8.5. Forename of mother
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2.2. Additional information on the person
2.2.1. Additional information on the person
2.2.1.1. Nationality
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2.2.1.2. Previous family name(s)
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2.2.1.3. Previous forename(s)
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2.2.2. Address
2.2.2.1. Street
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2.2.2.2. Building Name
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2.2.2.3. Town
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2.2.2.4. Postal Code
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2.2.2.5. Region
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2.2.2.6. Country
*
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3. Claimant (survivor's pension)
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3.1. Person identification
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3.1.1. Family name(s)
*
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3.1.2. Forename(s)
*
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3.1.3. Date of birth
*
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3.1.4. Sex
*
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3.1.5. Family name(s) at birth
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3.1.6. Forename(s) at birth
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3.1.7. PIN of the person in each institution
3.1.7.1. Personal Identification Number(s)
*
3.1.7.1.1. Country
*
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3.1.7.1.2. Personal Identification Number (PIN)
*
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3.1.7.1.3. Sector
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3.1.7.1.4. Institution
3.1.7.1.4.1. Institution ID
*
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3.1.7.1.4.2. Institution Name
*
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3.1.8. If PIN not provided for every institution, please provide
3.1.8.1. Place of birth
3.1.8.1.1. Town
*
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3.1.8.1.2. Region
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3.1.8.1.3. Country
*
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3.1.8.2. Father's family name at birth
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3.1.8.3. Forename of father
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3.1.8.4. Mother's family name at birth
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3.1.8.5. Forename of mother
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3.2. Additional information on the person
3.2.1. Additional information on the person
3.2.1.1. Nationality
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3.2.1.2. Previous family name(s)
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3.2.1.3. Previous forename(s)
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3.2.2. Address
3.2.2.1. Street
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3.2.2.2. Building Name
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3.2.2.3. Town
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3.2.2.4. Postal Code
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3.2.2.5. Region
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3.2.2.6. Country
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4. Additional information for old age pension claim
4.1. Additional information on the insured person's own personal care of the child
4.1.1. Person's own personal care of the child
4.1.1.1. Forename and Family name of the child
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4.1.1.2. Birth date of the child
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4.1.1.3. Start date of child raising period
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4.1.1.4. End date of child raising period
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4.1.1.5. Country of residence during child raising period
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4.1.1.6. Other custody of the child
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4.1.1.7. Place of the custody
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4.1.1.8. Start date of the custody
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4.1.1.9. End date of the custody
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4.2. Unable to provide the requested information in this section
4.2.1. Is the requested information available?
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4.2.2. Please fill in the following if the above is answered "No".
4.2.2.1. Reason
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5. Additional information for survivor's pension claim
5.1. Additional information on the claimant's benefit details
5.1.1. Fit for work declaration of the claimant
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5.1.2. The claimant is unfit for work
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5.2. Additional information on the deceased insured person's own personal care of the child
5.2.1. Person's own personal care of the child
5.2.1.1. Forename and Family name of the child
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5.2.1.2. Birth date of the child
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5.2.1.3. Start date of child raising period
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5.2.1.4. End date of child raising period
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5.2.1.5. Country of residence during child raising period
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5.2.1.6. Other custody of the child
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5.2.1.7. Place of the custody
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5.2.1.8. Start date of the custody
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5.2.1.9. End date of the custody
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5.3. Unable to provide the requested information in this section
5.3.1. Is the requested information available?
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5.3.2. Please fill in the following if the above is answered "No".
5.3.2.1. Reason
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6. Additional information for invalidity pension claim
6.1. Additional information on the insured person's own personal care of the child
6.1.1. Person's own personal care of the child
6.1.1.1. Forename and Family name of the child
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6.1.1.2. Birth date of the child
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6.1.1.3. Start date of child raising period
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6.1.1.4. End date of child raising period
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6.1.1.5. Country of residence during child raising period
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6.1.1.6. Other custody of the child
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6.1.1.7. Place of the custody
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6.1.1.8. Start date of the custody
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6.1.1.9. End date of the custody
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6.2. Unable to provide the requested information in this section
6.2.1. Is the requested information available?
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6.2.2. Please fill in the following if the above is answered "No".
6.2.2.1. Reason
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