P2100 - Survivor's pension claim
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. Insured person's pension details
3.1. Pension recipient at date of death
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3.2. Pension received
3.2.1. Pension type
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3.2.2. Institution
3.2.2.1. Institution
3.2.2.1.1. Institution ID
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3.2.2.1.2. Institution Name
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3.2.2.2. Case number
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3.2.3. Start date of pension right
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4. Insured person's death details
4.1. Place of death
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4.2. Date of death
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4.3. Cause of death
4.3.1. Cause of death
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4.3.2. Please fill in the following if "Cause of death" = "Other" :
4.3.2.1. Describe other cause of death
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5. Claimant
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5.1. Person identification
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5.1.1. Family name(s)
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5.1.2. Forename(s)
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5.1.3. Date of birth
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5.1.4. Sex
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5.1.5. Family name(s) at birth
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5.1.6. Forename(s) at birth
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5.1.7. PIN of the person in each institution
5.1.7.1. Personal Identification Number(s)
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5.1.7.1.1. Country
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5.1.7.1.2. Personal Identification Number (PIN)
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5.1.7.1.3. Sector
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5.1.7.1.4. Institution
5.1.7.1.4.1. Institution ID
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5.1.7.1.4.2. Institution Name
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5.1.8. If PIN not provided for every institution, please provide
5.1.8.1. Place of birth
5.1.8.1.1. Town
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5.1.8.1.2. Region
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5.1.8.1.3. Country
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5.1.8.2. Father's family name at birth
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5.1.8.3. Forename of father
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5.1.8.4. Mother's family name at birth
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5.1.8.5. Forename of mother
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5.2. Additional information on the person
5.2.1. Additional information on the person
5.2.1.1. Nationality
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5.2.1.2. Previous family name(s)
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5.2.1.3. Previous forename(s)
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5.2.2. Family status
5.2.2.1. Family Status
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5.2.2.2. Family status date
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5.2.3. Address
5.2.3.1. Street
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5.2.3.2. Building Name
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5.2.3.3. Town
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5.2.3.4. Postal Code
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5.2.3.5. Region
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5.2.3.6. Country
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5.2.4. Contact information on the person
5.2.4.1. Telephone Numbers
5.2.4.1.1. Telephone Number
5.2.4.1.1.1. Type
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5.2.4.1.1.2. Number
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5.2.4.2. Email Addresses
5.2.4.2.1. Email Address
5.2.4.2.1.1. Email Address
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5.2.5. Relationship to the insured person
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5.2.6. Same household with the insured person
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5.2.7. Please fill in the following if "Same household with the insured person" = "Yes" :
5.2.7.1. Start date of living together
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5.3. Additional information on the claimant when the claimant is not a child of the insured person
5.3.1. Date of marriage or registered partnership with the insured person
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5.3.2. Common children of the claimant and the insured person
5.3.2.1. Did the claimant and the insured person have (had) a child in common?
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5.3.2.2. If the claimant is expecting a child, state the expected date of birth for the child
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5.3.3. Separation type
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5.3.4. Marriage or registered partnership after the death of the insured person
5.3.4.1. Date of marriage or registered partnership after the death of the insured person
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5.3.4.2. New spouse / partner of the claimant
5.3.4.2.1. Family name(s)
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5.3.4.2.2. Forename(s)
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5.4. Living together with new spouse/partner
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6. Claimant's employment and self-employment details
6.1. Employment and self-employment details
6.1.1. Occupation
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6.1.2. Employment and self-employment
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6.1.3. Start date of intended employment or self-employment
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6.1.4. End date of employment or self-employment
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6.1.5. Intended retirement date from employment or self-employment
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6.1.6. Hours per week
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6.1.7. Income amount
6.1.7.1. Amount
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6.1.7.2. Currency
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6.1.7.3. Amount effective since
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6.1.7.4. Payment frequency
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6.1.7.5. Please fill in the following if "Payment frequency" = "Other" :
6.1.7.5.1. Other payment frequency
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7. Claimant's benefit details
7.1. Benefit details
7.1.1. Benefits
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7.1.2. Please fill in the following if "Benefits" = "Other benefits"
7.1.2.1. Other benefit(s)
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7.1.3. Status
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7.1.4. Institution
7.1.4.1. Institution
7.1.4.1.1. Institution ID
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7.1.4.1.2. Institution Name
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7.1.4.2. Case number
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7.1.5. Start date of benefits payment
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7.1.6. End date of benefits payment
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7.1.7. Start date of entitlement to benefits
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7.1.8. End date of entitlement to benefits
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7.1.9. Amount
7.1.9.1. Amount
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7.1.9.2. Currency
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7.1.9.3. Amount effective since
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7.1.9.4. Payment frequency
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7.1.9.5. Please fill in the following if "Payment frequency" = "Other" :
7.1.9.5.1. Other payment frequency
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7.2. Entitlement to sickness benefits in kind
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8. Claimant's children
8.1. Child
8.1.1. Person identification
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8.1.1.1. Family name(s)
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8.1.1.2. Forename(s)
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8.1.1.3. Date of birth
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8.1.1.4. Sex
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8.1.1.5. Family name(s) at birth
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8.1.1.6. Forename(s) at birth
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8.1.1.7. PIN of the person in each institution
8.1.1.7.1. Personal Identification Number(s)
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8.1.1.7.1.1. Country
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8.1.1.7.1.2. Personal Identification Number (PIN)
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8.1.1.7.1.3. Sector
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8.1.1.7.1.4. Institution
8.1.1.7.1.4.1. Institution ID
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8.1.1.7.1.4.2. Institution Name
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8.1.1.8. If PIN not provided for every institution, please provide
8.1.1.8.1. Place of birth
8.1.1.8.1.1. Town
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8.1.1.8.1.2. Region
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8.1.1.8.1.3. Country
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8.1.1.8.2. Father's family name at birth
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8.1.1.8.3. Forename of father
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8.1.1.8.4. Mother's family name at birth
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8.1.1.8.5. Forename of mother
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8.1.2. Additional information on the person
8.1.2.1. Nationality
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8.1.2.2. Relationship to the claimant
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8.1.2.3. Please fill in the following if "Relationship to the claimant" = "Other child"
8.1.2.3.1. Specifics on "Other child"
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8.1.2.4. Date of Death
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9. Information on representative/legal guardian
9.1. Family name
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9.2. Forename
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9.3. Grounds
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9.4. Address
9.4.1. Street
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9.4.2. Building Name
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9.4.3. Town
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9.4.4. Postal Code
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9.4.5. Region
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9.4.6. Country
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9.5. Contact information on the person
9.5.1. Telephone Numbers
9.5.1.1. Telephone Number
9.5.1.1.1. Type
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9.5.1.1.2. Number
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9.5.2. Email Addresses
9.5.2.1. Email Address
9.5.2.1.1. Email Address
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10. Information on payment
10.1. Payment to
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10.2. Bank information
10.2.1. Account holder name
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SEPA Account
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Non-SEPA Account
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10.2.2.1. IBAN
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10.2.2.2. BIC-SWIFT
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10.2.3.1. Account Number
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10.2.3.2. BIC-SWIFT
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10.2.3.3. Bank Name
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10.2.3.4. Bank Address
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10.2.3.4.1. Street
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10.2.3.4.2. Building Name
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10.2.3.4.3. Town
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10.2.3.4.4. Postal Code
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10.2.3.4.5. Region
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10.2.3.4.6. Country
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11. Miscellaneous
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11.1. Date of claim
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11.2. Recipient of the decision
11.2.1. Recipient of the decision
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11.3. Deductions grounds
11.3.1. Deductions grounds
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11.4. Attachments
11.4.1. Attachments
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11.4.2. Please fill in the following if "Attachments" = "Other" :
11.4.2.1. Other attachment
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11.5. Requested documents
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11.6. Additional information
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11.7. Number of known claimants related to the insured person
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