P3000_PL - Country specific information - Poland
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)
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)
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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
4.1.1. Father's forenames
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4.1.2. Mother's family name at birth
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4.1.3. Mother's forenames
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4.1.4. The last address of permanent stay in Poland
4.1.4.1. Street
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4.1.4.2. Building Name
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4.1.4.3. Town
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4.1.4.4. Postal Code
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4.1.4.5. Region
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4.1.4.6. Country
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4.1.5. NIP number
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4.1.6. Case number of the sending institution
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4.1.7. Case number in the receiving institution
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4.1.8. Farm ownership
4.1.8.1. Farm owner/holder
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4.1.8.2. Area of the farm in hectares
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4.1.9. Duty before exemption
4.1.9.1. Duty before exemption
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4.1.9.2. Type of duty and the date of exemption
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4.1.10. Reassess pension amount
4.1.10.1. To reassess pension amount, the insured person applies for
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4.1.10.2. The insured person declares that he/she will receive remuneration or similar benefit in cash after exemption from duty
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4.1.10.3. Please fill in the following if "The insured person declares that he/she will receive remuneration or similar benefit in cash after exemption from duty" = "Yes" :
4.1.10.3.1. Period of receiving
4.1.10.3.1.1. Start Date
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4.1.10.3.1.2. End Date
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4.1.11. Police pension
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4.1.12. The insured person declares that he/she is totally incapable of performing duties and current invalidity is related to performed duties
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4.1.13. Has the insured person been sentenced by valid judgement for an offence related to carrying out professional duties?
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4.1.14. Is criminal proceedings conducted, related to an offence related to carrying out professional duties?
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4.1.15. Military pension
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4.1.16. Prosecutorial retirement benefits
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4.1.17. Family benefits for the family members of the deceased prosecutor
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4.1.18. Judicial retirement benefits
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4.1.19. Family benefits for the family members of the deceased judge
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4.2. Additional information on the insured person's employment and self-employment details
4.2.1. Employment and self-employment details
4.2.1.1. Income from employment
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4.2.1.2. Amount
4.2.1.2.1. Amount
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4.2.1.2.2. Currency
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4.2.1.2.3. Amount effective since
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4.2.1.2.4. Payment frequency
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4.2.1.2.5. Please fill in the following if "Payment frequency" = "Other" :
4.2.1.2.5.1. Other payment frequency
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4.2.1.3. Employment type
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4.2.1.4. Income starting date (starting date since when the insured person intends to receive income)
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4.2.1.5. Income covered by compulsory insurance (contributions) in a Member State where obtained
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4.2.1.6. Other resources - sources of income
4.2.1.6.1. Other resources - sources of income
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4.2.1.6.2. Type of other resources - sources of income
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4.2.1.6.3. Amount
4.2.1.6.3.1. Amount
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4.2.1.6.3.2. Currency
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4.2.1.6.3.3. Amount effective since
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4.2.1.6.3.4. Payment frequency
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4.2.1.6.3.5. Please fill in the following if "Payment frequency" = "Other" :
4.2.1.6.3.5.1. Other payment frequency
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4.2.1.7. Insured person states no income
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4.2.1.8. Gainful employment intended
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4.2.1.9. Income type
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4.2.1.10. The last activity before retirement
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4.3. Additional information on the insured person's benefit details
4.3.1. Request for old-age pension which depends on employment in a specific occupation or special conditions
4.3.1.1. Request for old-age pension which depends on employment in a specific occupation or special conditions
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4.3.1.2. Type of occupation or special conditions
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4.3.2. Request for old-age pension which depends on disability
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4.3.3. Constant attendance declaration of the insured person
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4.4. Additional information on the spouse
4.4.1. Pension recipient
4.4.1.1. Pension recipient
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4.4.1.2. Pension type
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4.4.1.3. Pension number
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4.4.2. Institution
4.4.2.1. Institution
4.4.2.1.1. Country
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4.4.2.1.2. Personal Identification Number (PIN)
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4.4.2.1.3. Sector
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4.4.2.1.4. Institution
4.4.2.1.4.1. Institution ID
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4.4.2.1.4.2. Institution Name
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4.4.3. Farm ownership
4.4.3.1. Farm owner/holder
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4.4.3.2. Area of the farm in hectares
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4.5. Additional miscellaneous information
4.5.1. The insured person is in Poland a Member of the Open Pension Fund (Otwarty Fundusz Emerytalny)
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4.5.2. The insured person requests for transfer of the funds from the Open Pension Fund (Otwarty Fundusz Emerytalny) account via ZUS on revenue side of the State Budget to obtain early retirement pension
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4.5.3. Initial capital (concerns persons born after 31.12.1948)
4.5.3.1. A claim for the calculating of initial capital was submitted previously by the insured person
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4.5.3.2. If yes, please give name of ZUS Branch Office competent for calculating of initial capital and case reference number in this ZUS for the case of initial capital
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4.5.4. Presently the insured person requests for calculating of initial capital
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4.5.5. The insured person applies for the following to be accepted as pension assessment basis
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4.5.6. Please fill in the following if "The insured person applies for the following to be accepted as pension assessment basis" = "Average basis of contribution assessment for social insurance or old-age and disability insurance according to Polish regulations, in the period of 10 subsequent calendar years, selected from the past 20 calendar years, immediately preceding the year in which the claim was submitted (from-to)" :
4.5.6.1. Period
4.5.6.1.1. Start Date
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4.5.6.1.2. End Date
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4.5.7. Claim for the comparison if a calculation of amount of old-age pension according to new rules (concerns persons born before 1.01.1949) is more favourable than a calculation according to the old rules
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4.5.8. The insured person has got PESEL No in Poland
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4.5.9. Please fill in the following if "The insured person has got PESEL No in Poland" = "Yes" :
4.5.9.1. PESEL No
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4.5.10. The insured person
4.5.10.1. The insured person
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4.5.10.2. Please fill in the following if "The insured person" = "Is not able to provide documents proving periods of insurance or salaries during insurance in Poland "
4.5.10.2.1. Documents which couldn't be provided
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4.5.10.2.2. Reason
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4.6. Unable to provide the requested information in this section
4.6.1. Is the requested information available?
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4.6.2. Please fill in the following if the above is answered "No".
4.6.2.1. Reason
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5. Additional information for survivor's pension claim
5.1. Additional information on the claimant
5.1.1. Father's forenames
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5.1.2. Mother's family name at birth
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5.1.3. Mother's forenames
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5.1.4. NIP number
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5.1.5. Case number in the sending institution
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5.1.6. Case number in the receiving institution
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5.1.7. Dependent from the insured person
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5.1.8. The last address of permanent stay in Poland
5.1.8.1. Street
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5.1.8.2. Building Name
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5.1.8.3. Town
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5.1.8.4. Postal Code
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5.1.8.5. Region
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5.1.8.6. Country
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5.1.9. Farm ownership
5.1.9.1. Farm owner/holder
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5.1.9.2. Area of the farm in hectares
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5.1.10. Family benefits for the family members of the deceased prosecutor or judge
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5.1.11. Information on widow/widower applying for Polish survivor's pension
5.1.11.1. Was there a conjugal community until the day of spouse's death?
{{option.name}}
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{{metaSection.wasThereAConjugalCommunityUntilDaySpouseDeathIndicator.$$warning}}
5.1.11.2. Spouses were living together
{{option.name}}
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{{metaSection.spousesWereLivingTogetherIndicator.$$warning}}
5.1.11.3. Spouses were running mutual household
{{option.name}}
{{metaSection.spousesWereRunningMutualHouseholdIndicator.$$error}}
{{metaSection.spousesWereRunningMutualHouseholdIndicator.$$warning}}
5.1.11.4. Was the right to receive from spouse alimony established at the date of the spouse death
{{option.name}}
{{metaSection.wasRightEstablishedAtDateSpouseDeathIndicator.$$error}}
{{metaSection.wasRightEstablishedAtDateSpouseDeathIndicator.$$warning}}
5.1.12. Information on the parents applying for Polish survivor's pension
5.1.12.1. Was the deceased insured person contributing to maintaining the claimant directly before death?
{{option.name}}
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{{metaSection.wasDeceasedInsuredContributingClaimantBeforeDeathIndicator.$$warning}}
5.1.12.2. Please fill in the following if "Was the deceased insured person contributing to maintaining the claimant directly before death?" = "Yes" :
5.1.12.2.1. Details
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5.1.12.3. Is the claimant bringing up a child (aged up to 16) of the deceased insured person or, if the child has been attending a school, aged up to 18
{{option.name}}
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{{metaSection.isClaimantGrowUpAChildDeceasedInsuredOrChildSchoolIndicator.$$warning}}
5.1.12.4. Is the claimant taking care of a child which is totally incapable of working and living independently or is totally incapable of working and which has right to receive survivor/s pension
{{option.name}}
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{{metaSection.isClaimantTakingCareIncapableWorkingChildWithRightIndicator.$$warning}}
5.1.12.5. If yes, please indicate the surname and the forename of the child
5.1.12.5.1. Surname and forename of the child
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{{metaSection.surnameForenameChild.$$warning}}
5.1.13. Information on child applying for Polish survivor's pension
5.1.13.1. Family relations with deceased insured person
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{{metaSection.familyRelationsWithDeceasedInsuredPerson.$$warning}}
5.1.13.2. The name of school
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{{metaSection.theNameSchool.$$warning}}
5.1.13.3. Is a child totally incapable of working and to living independently or is totally incapable of working and has right to receive survivor's pension?
{{option.name}}
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{{metaSection.hasTotallyIncapableChildRightSurvivorPensionIndicator.$$warning}}
5.1.13.4. In the case of children accepted to be brought up and maintained before the reach 18, grandchildren, brother(s) or sister(s) or other children, including children from foster family, please indicate the following:
{{option.name}}
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{{metaSection.inCaseChildrenAcceptedBroughtUpMaintainedProvideIndicator.$$warning}}
5.1.13.5. Are the child's parents alive?
{{option.name}}
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{{metaSection.areChildParentsAliveIndicator.$$warning}}
5.1.13.6. If yes, please answer the following questions:
5.1.13.6.1. Are they able to maintain the child?
{{option.name}}
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{{metaSection.areTheyAbleMaintainChildIndicator.$$warning}}
5.1.13.6.2. Was the deceased insured person or his/her spouse a guardian of the child ordered by court?
{{option.name}}
{{metaSection.wasDeceasedOrSpouseGuardianChildOrderedByCourtIndicator.$$error}}
{{metaSection.wasDeceasedOrSpouseGuardianChildOrderedByCourtIndicator.$$warning}}
5.1.13.6.3. Does the child have the right to receive a survivor's pension due to the death of his/her parents?
{{option.name}}
{{metaSection.hasChildRightReceiveSurvivorPensionFromParentsIndicator.$$error}}
{{metaSection.hasChildRightReceiveSurvivorPensionFromParentsIndicator.$$warning}}
5.2. Additional information on the claimant's employment and self-employment details
5.2.1. Employment and self-employment details
5.2.1.1. Employment income
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{{metaSection.employmentIncome.$$warning}}
5.2.1.2. Employment type
{{option.name}}
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{{metaSection.employment.$$warning}}
5.2.1.3. Amount
5.2.1.3.1. Amount
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{{metaSection.amount.$$warning}}
5.2.1.3.2. Currency
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5.2.1.3.3. Amount effective since
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5.2.1.3.4. Payment frequency
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{{metaSection.paymentFrequency.$$warning}}
5.2.1.3.5. Please fill in the following if "Payment frequency" = "Other" :
5.2.1.3.5.1. Other payment frequency
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{{metaSection.otherPaymentFrequency.$$warning}}
5.2.1.4. Income starting date (starting date since when the claimant intends to receive income)
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{{metaSection.incomeStartingDateAfterClaimantIntendsReceiveIncome.$$warning}}
5.2.1.5. Income covered by compulsory insurance (contributions) in a Member State where obtained
{{option.name}}
{{metaSection.incomeCoveredByCompulsoryInsuranceStateWhereObtained.$$error}}
{{metaSection.incomeCoveredByCompulsoryInsuranceStateWhereObtained.$$warning}}
5.2.1.6. Income Amount
5.2.1.6.1. Amount
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{{metaSection.amount.$$warning}}
5.2.1.6.2. Currency
{{$select.selected[ 'name']}}
{{metaSection.currency.$$error}}
{{metaSection.currency.$$warning}}
5.2.1.6.3. Amount effective since
{{metaSection.amountEffectiveSince.$$error}}
{{metaSection.amountEffectiveSince.$$warning}}
5.2.1.6.4. Payment frequency
{{$select.selected[ 'name']}}
{{metaSection.paymentFrequency.$$error}}
{{metaSection.paymentFrequency.$$warning}}
5.2.1.6.5. Please fill in the following if "Payment frequency" = "Other" :
5.2.1.6.5.1. Other payment frequency
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{{metaSection.otherPaymentFrequency.$$warning}}
5.2.1.7. Other resources - sources of income
5.2.1.7.1. Other resources - sources of income
{{option.name}}
{{metaSection.otherResourcesSourcesIncomeIndicator.$$error}}
{{metaSection.otherResourcesSourcesIncomeIndicator.$$warning}}
5.2.1.7.2. Type of other resources - sources of income
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{{metaSection.typeOtherResourcesSourcesIncome.$$warning}}
5.2.1.7.3. Amount
5.2.1.7.3.1. Amount
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{{metaSection.amount.$$warning}}
5.2.1.7.3.2. Currency
{{$select.selected[ 'name']}}
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{{metaSection.currency.$$warning}}
5.2.1.7.3.3. Amount effective since
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5.2.1.7.3.4. Payment frequency
{{$select.selected[ 'name']}}
{{metaSection.paymentFrequency.$$error}}
{{metaSection.paymentFrequency.$$warning}}
5.2.1.7.3.5. Please fill in the following if "Payment frequency" = "Other" :
5.2.1.7.3.5.1. Other payment frequency
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{{metaSection.otherPaymentFrequency.$$warning}}
5.2.1.8. Claimant states no income
{{option.name}}
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{{metaSection.claimantStatesNoIncomeIndicator.$$warning}}
5.3. Additional information on the claimant's benefit details
5.3.1. Constant attendance declaration of the claimant
{{option.name}}
{{metaSection.constantAttendanceDeclarationClaimant.$$error}}
{{metaSection.constantAttendanceDeclarationClaimant.$$warning}}
5.4. Additional information on the deceased insured person
5.4.1. Duty before exemption
5.4.1.1. Type of duty and the date of exemption
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{{metaSection.typeDutyDateExemption.$$warning}}
5.4.1.2. Police pension
{{option.name}}
{{metaSection.policePensionIndicator.$$error}}
{{metaSection.policePensionIndicator.$$warning}}
5.4.1.3. Concerning the death of the officer, has/was an application made for granting and paying compensation due in the case of accidents or diseases in connection with his/her duty?
{{option.name}}
{{metaSection.concernDeceasedOfficerAppliedGrantingCompensationIndicator.$$error}}
{{metaSection.concernDeceasedOfficerAppliedGrantingCompensationIndicator.$$warning}}
5.4.1.4. Concerning the death of the officer, have/has criminal proceedings made in connection with his/her duty?
{{option.name}}
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{{metaSection.concernDeceasedOfficerCriminalProceedingWithDutyIndicator.$$warning}}
5.4.1.5. Has the death or disappearance of the officer occurred while on duty outside Polish territory?
{{option.name}}
{{metaSection.hasDeathDisappearanceOccurredOnDutyOutsidePolishIndicator.$$error}}
{{metaSection.hasDeathDisappearanceOccurredOnDutyOutsidePolishIndicator.$$warning}}
5.4.1.6. Has the dead person been sentenced by valid judgement for an offence related to carrying out professional duties?
{{option.name}}
{{metaSection.hasDeadPersonSentencedByJudgementOffenceDuringDutyIndicator.$$error}}
{{metaSection.hasDeadPersonSentencedByJudgementOffenceDuringDutyIndicator.$$warning}}
5.4.2. Military pension
5.4.2.1. Military pension
{{option.name}}
{{metaSection.militaryPensionIndicator.$$error}}
{{metaSection.militaryPensionIndicator.$$warning}}
5.4.2.2. Please fill in whether the death of the soldier after exemption from duty occurred:
5.4.2.2.1. As a result of an accident while in active military service or a disease connected with particular qualities or conditions of military services?
{{option.name}}
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{{metaSection.accidentWhileMilitaryDiseaseDuringMilitaryServicesIndicator.$$warning}}
5.4.2.2.2. As a result of injuries received while on duty or diseases occurred at the time of duty?
{{option.name}}
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{{metaSection.resultInjuriesOrDiseasesReceivedWhileDutyIndicator.$$warning}}
5.4.2.2.3. Has the death or disappearance of the soldier occurred at the time of duty outside Polish Territory?
{{option.name}}
{{metaSection.hasDeathDisappearanceDuringDutyOutsidePolandIndicator.$$error}}
{{metaSection.hasDeathDisappearanceDuringDutyOutsidePolandIndicator.$$warning}}
5.4.2.3. Prosecutorial retirement benefits
{{option.name}}
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{{metaSection.prosecutorialRetirementBenefitsIndicator.$$warning}}
5.4.2.4. Judicial retirement benefits
{{option.name}}
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{{metaSection.judicialRetirementBenefitsIndicator.$$warning}}
5.5. Additional information on the deceased insured person's benefit details
5.5.1. Type of pension scheme
{{option.name}}
{{metaSection.typePensionScheme.$$error}}
{{metaSection.typePensionScheme.$$warning}}
5.5.2. End date of pension payment
{{metaSection.endDatePensionPayment.$$error}}
{{metaSection.endDatePensionPayment.$$warning}}
5.5.3. Postponed pension payment
{{option.name}}
{{metaSection.postponedPensionPaymentIndicator.$$error}}
{{metaSection.postponedPensionPaymentIndicator.$$warning}}
5.5.4. Deferment country
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{{metaSection.defermentCountry.$$warning}}
5.5.5. The insured person received at the date of death any Polish benefits other than pension
{{option.name}}
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{{metaSection.insuredReceivedDeathPolishBenefitsOtherThanPensionIndicator.$$warning}}
5.5.6. If yes, please indicate the following:
5.5.6.1. Kind of the benefit
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5.5.6.2. Name of the institution
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5.5.6.3. Case number in the institution
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{{metaSection.caseNumberInInstitution.$$warning}}
5.6. Additional information on the children of the deceased insured person
5.6.1. Name of the child
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5.6.2. Name of the school
{{metaSection.nameSchool.$$error}}
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5.6.3. Family relations with the insured person
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{{metaSection.familyRelationsWithInsuredPerson.$$warning}}
5.6.4. Child unable to work
5.6.4.1. Unable to work
{{option.name}}
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{{metaSection.unableWorkIndicator.$$warning}}
5.6.4.2. Unable to work and live independently
{{option.name}}
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{{metaSection.unableWorkLiveIndependentlyIndicator.$$warning}}
5.6.5. In the case of children accepted to be brought and maintained before they reach 18, grandchildren, brother(s) or sister(s) or other children, including children from foster family, please indicate the following
5.6.5.1. The exact date of accepting them to be brought up and maintained
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{{metaSection.theExactDateAcceptingBroughtUpMaintained.$$warning}}
5.6.5.2. Are the child's parents alive?
{{option.name}}
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{{metaSection.areChildParentsAliveIndicator.$$warning}}
5.6.5.3. If yes, please answer the following questions:
5.6.5.3.1. Are they able to maintain the child?
{{option.name}}
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{{metaSection.areTheyAbleMaintainChildIndicator.$$warning}}
5.6.5.3.2. Was the deceased insured person or his/her spouse a guardian of the child ordered by court?
{{option.name}}
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{{metaSection.wasDeceasedOrSpouseGuardianChildOrderedByCourtIndicator.$$warning}}
5.6.5.3.3. Does the child have the right to receive a survivor's pension due to the death of his/her parents?
{{option.name}}
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{{metaSection.hasChildRightReceiveSurvivorPensionDueParentsDeathIndicator.$$warning}}
5.7. Additional information on the claimant's spouse
5.7.1. Farm ownership
5.7.1.1. Farm owner/holder
{{option.name}}
{{metaSection.farmOwnerHolderIndicator.$$error}}
{{metaSection.farmOwnerHolderIndicator.$$warning}}
5.7.1.2. Area of the farm in hectares
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{{metaSection.areaFarmInHectares.$$warning}}
5.8. Additional miscellaneous information
5.8.1. The insured person was in Poland a Member of the Open Pension Fund (Otwarty Fundusz Emerytalny)
{{option.name}}
{{metaSection.theInsuredInPolandMemberOpenPensionFundIndicator.$$error}}
{{metaSection.theInsuredInPolandMemberOpenPensionFundIndicator.$$warning}}
5.8.2. Initial capital (concerns persons born after 31.12.1948)
5.8.2.1. Claim for the calculating of initial capital was submitted previously by the deceased insured person
{{option.name}}
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{{metaSection.claimCalculatingInitialCapitalSubmittedByDeceasedIndicator.$$warning}}
5.8.2.2. If yes, please give name of ZUS Branch Office competent for calculating of initial capital and case reference number in this ZUS for the case of initial capital for the deceased insured person
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{{metaSection.giveNameZUSBranchOfficeCompetentDeceasedInsured.$$warning}}
5.8.3. Presently the claimant requests for calculating of initial capital for the deceased insured person
{{option.name}}
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{{metaSection.claimantRequestsCalculatingInitialCapitalDeceasedIndicator.$$warning}}
5.8.4. The claimant applies for the following to be accepted as pension assessment basis
{{$select.selected[ 'name']}}
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{{metaSection.claimantAppliesFollowingAcceptedPensionAssessmentBasis.$$warning}}
5.8.5. Please fill in the following if "The claimant applies for the following to be accepted as pension assessment basis" = "Average basis of contribution assessment of the deceased insured person for social insurance or old-age and disability insurance according to Polish regulations, in the period of 10 subsequent calendar years, selected from the past 20 calendar years, immediately preceding the year in which the claim was submitted (from-to) " :
5.8.5.1. Period
5.8.5.1.1. Start Date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
5.8.5.1.2. End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
5.8.6. The claimant has got PESEL No in Poland
{{option.name}}
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{{metaSection.theClaimantHasGotPESELNoInPolandIndicator.$$warning}}
5.8.7. Please fill in the following if "The claimant has got PESEL No in Poland" = "Yes" :
5.8.7.1. PESEL No
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{{metaSection.pESELNo.$$warning}}
5.8.8. The deceased insured person had got PESEL No in Poland
{{option.name}}
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{{metaSection.theDeceasedInsuredPersonHadGotPESELNoInPolandIndicator.$$warning}}
5.8.9. Please fill in the following if "The deceased insured person had got PESEL No in Poland" = "Yes" :
5.8.9.1. PESEL No
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{{metaSection.pESELNo.$$warning}}
5.8.10. Cause of death
{{option.name}}
{{metaSection.causeDeath.$$error}}
{{metaSection.causeDeath.$$warning}}
5.8.11. Claimant
5.8.11.1. Claimant
{{option.name}}
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{{metaSection.claimant.$$warning}}
5.8.11.2. Please fill in the following if "Claimant" = "Is not able to provide documents of the deceased insured person proving periods of insurance or salaries during insurance in Poland " :
5.8.11.2.1. Documents which couldn't be provided
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{{metaSection.documentsWhichCouldNotProvided.$$warning}}
5.8.11.2.2. Reason
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5.9. Unable to provide the requested information in this section
5.9.1. Is the requested information available?
{{option.name}}
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{{metaSection.isRequestedInformationAvailableIndicator.$$warning}}
5.9.2. Please fill in the following if the above is answered "No".
5.9.2.1. Reason
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{{metaSection.reason.$$warning}}
6. Additional information for invalidity pension claim
6.1. Additional information on the insured person
6.1.1. Father's forenames
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6.1.2. Mother's family name at birth
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{{metaSection.motherFamilyNameAtBirth.$$warning}}
6.1.3. Mother's forenames
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{{metaSection.motherForenames.$$warning}}
6.1.4. NIP number
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{{metaSection.nIPNumber.$$warning}}
6.1.5. Case number in the sending institution
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{{metaSection.caseNumberInSendingInstitution.$$warning}}
6.1.6. Case number in the receiving institution
{{metaSection.caseNumberInReceivingInstitution.$$error}}
{{metaSection.caseNumberInReceivingInstitution.$$warning}}
6.1.7. The last address of permanent stay in Poland
6.1.7.1. Street
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{{metaSection.street.$$warning}}
6.1.7.2. Building Name
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
6.1.7.3. Town
*
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
6.1.7.4. Postal Code
{{metaSection.postalCode.$$error}}
{{metaSection.postalCode.$$warning}}
6.1.7.5. Region
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6.1.7.6. Country
*
{{$select.selected[ 'name']}}
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{{metaSection.country.$$warning}}
6.1.8. Farm ownership
6.1.8.1. Farm owner/holder
{{option.name}}
{{metaSection.farmOwnerHolderIndicator.$$error}}
{{metaSection.farmOwnerHolderIndicator.$$warning}}
6.1.8.2. Area of the farm in hectares
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{{metaSection.areaFarmInHectares.$$warning}}
6.1.9. The insured person became disabled because of an accident on way to work or from work
{{option.name}}
{{metaSection.insuredBecameDisabledDueToAccidentToOrFromWorkWayIndicator.$$error}}
{{metaSection.insuredBecameDisabledDueToAccidentToOrFromWorkWayIndicator.$$warning}}
6.1.10. Duty before exemption
6.1.10.1. Type of duty and the date of exemption
{{metaSection.typeDutyDateExemption.$$error}}
{{metaSection.typeDutyDateExemption.$$warning}}
6.1.11. Reassess pension amount
6.1.11.1. To reassess pension amount, the insured person applies for
{{option.name}}
{{metaSection.toReassessPensionAmountInsuredPersonAppliesFor.$$error}}
{{metaSection.toReassessPensionAmountInsuredPersonAppliesFor.$$warning}}
6.1.11.2. The insured person declares that he/she will receive remuneration or similar benefit in cash after exemption from duty
{{option.name}}
{{metaSection.insuredWillReceiveRemunerationInCashAfterExemptionIndicator.$$error}}
{{metaSection.insuredWillReceiveRemunerationInCashAfterExemptionIndicator.$$warning}}
6.1.11.3. Please fill in the following if "The insured person declares that he/she will receive remuneration or similar benefit in cash after exemption from duty" = "Yes" :
6.1.11.3.1. Period of receiving
6.1.11.3.1.1. Start Date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
6.1.11.3.1.2. End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
6.1.12. Police pension
{{option.name}}
{{metaSection.policePensionIndicator.$$error}}
{{metaSection.policePensionIndicator.$$warning}}
6.1.13. Has the insured person been sentenced by valid judgement for an offence related to carrying out professional duties?
{{option.name}}
{{metaSection.hasInsuredSentencedByJudgementForOffenceDuringDutyIndicator.$$error}}
{{metaSection.hasInsuredSentencedByJudgementForOffenceDuringDutyIndicator.$$warning}}
6.1.14. Is criminal proceedings conducted, related to an offence related to carrying out professional duties?
{{option.name}}
{{metaSection.isCriminalProceedingsConductedForOffenceDuringDutyIndicator.$$error}}
{{metaSection.isCriminalProceedingsConductedForOffenceDuringDutyIndicator.$$warning}}
6.1.15. Military pension
{{option.name}}
{{metaSection.militaryPensionIndicator.$$error}}
{{metaSection.militaryPensionIndicator.$$warning}}
6.1.16. Prosecutorial retirement benefits
{{option.name}}
{{metaSection.prosecutorialRetirementBenefitsIndicator.$$error}}
{{metaSection.prosecutorialRetirementBenefitsIndicator.$$warning}}
6.1.17. Family benefits for the family members of the deceased prosecutor
{{option.name}}
{{metaSection.familyBenefitsForFamilyMembersDeceasedProsecutorIndicator.$$error}}
{{metaSection.familyBenefitsForFamilyMembersDeceasedProsecutorIndicator.$$warning}}
6.1.18. Judicial retirement benefits
{{option.name}}
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{{metaSection.judicialRetirementBenefitsIndicator.$$warning}}
6.1.19. Family benefits for the family members of the deceased judge
{{option.name}}
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{{metaSection.familyBenefitsForFamilyMembersDeceasedJudgeIndicator.$$warning}}
6.2. Additional information on the insured person's employment and self-employment details
6.2.1. Insured person states no income
{{option.name}}
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{{metaSection.insuredPersonStatesNoIncomeIndicator.$$warning}}
6.2.2. Employment type
{{option.name}}
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{{metaSection.employment.$$warning}}
6.3. Additional information on the spouse
6.3.1. Pension recipient
6.3.1.1. Pension recipient
{{option.name}}
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{{metaSection.pensionRecipient.$$warning}}
6.3.1.2. Pension type
{{option.name}}
{{metaSection.pension.$$error}}
{{metaSection.pension.$$warning}}
6.3.1.3. Pension number
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{{metaSection.pensionNumber.$$warning}}
6.3.2. Farm ownership
6.3.2.1. Farm owner/holder
{{option.name}}
{{metaSection.farmOwnerHolderIndicator.$$error}}
{{metaSection.farmOwnerHolderIndicator.$$warning}}
6.3.2.2. Area of the farm in hectares
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{{metaSection.areaFarmInHectares.$$warning}}
6.3.3. Institution
6.3.3.1. Institution
6.3.3.1.1. Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
6.3.3.1.2. Personal Identification Number (PIN)
*
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
6.3.3.1.3. Sector
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{{metaSection.sector.$$warning}}
6.3.3.1.4. Institution
6.3.3.1.4.1. Institution ID
*
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
6.3.3.1.4.2. Institution Name
*
{{metaSection.institutionName.$$error}}
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6.4. Additional miscellaneous information
6.4.1. The insured person is in Poland a Member of the Open Pension Fund (Otwarty Fundusz Emerytalny)
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6.4.2. Initial capital (concerns persons born after 31.12.1948)
6.4.2.1. Claim for the calculating of initial capital was submitted previously by the insured person
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6.4.2.2. If yes, please give name of ZUS Branch Office competent for calculating of initial capital and case reference number in this ZUS for the case of initial capital for the deceased insured person
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6.4.3. The insured person applies for the following to be accepted as pension assessment basis
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6.4.4. Please fill in the following if "The insured person applies for the following to be accepted as pension assessment basis" = "Average basis of contribution assessment for social insurance or old-age and disability insurance according to Polish regulations, in the period of 10 subsequent calendar years, selected from the past 20 calendar years, immediately preceding the year in which the claim was submitted (from-to)" :
6.4.4.1. Period
6.4.4.1.1. Start Date
*
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6.4.4.1.2. End Date
*
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6.4.5. The insured person has got PESEL No in Poland
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6.4.6. Please fill in the following if "The insured person has got PESEL No in Poland" = "Yes" :
6.4.6.1. PESEL No
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6.4.7. The insured person
6.4.7.1. The insured person
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6.4.7.2. Please fill in the following if "The insured person" = "Is not able to provide documents proving periods of insurance or salaries during insurance in Poland "
6.4.7.2.1. Documents which couldn't be provided
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6.4.7.2.2. Reason
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6.5. Unable to provide the requested information in this section
6.5.1. Is the requested information available?
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6.5.2. Please fill in the following if the above is answered "No".
6.5.2.1. Reason
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