Request Family Info

U005 - Request Family Info
Article 5 of Regulation (EC) No 883/2004; Article 54(3) 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. 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. Nationality

3. Person's current address

3.1. Address details *

3.1.1. Street

3.1.2. Building Name

3.1.3. Town *

3.1.4. Postal Code

3.1.5. Region

3.1.6. Country *

3.2. Contact information

3.2.1. Telephone Numbers

3.2.1.1. Telephone Number

3.2.1.1.1. Type

3.2.1.1.2. Number *

3.2.1.1.Telephone Number

3.2.2. Email Addresses

3.2.2.1. Email Address

3.2.2.1.1. Email Address

3.2.2.1.Email Address

4. Reference period *

Fixed period*
Open period*

4.1.1. Start date *

4.1.2. End date *

4.2.1. Type of Open Period *

4.2.2. Start date *

5. Benefits claims details

5.1. Benefits claim details

5.1.1. Details

5.1.2. Office information

5.1.2.1. Institution ID is known *

Please fill in the following if "Institution ID is known" = "Yes" :
Please fill in the following if "Institution ID is known" = "No" :

5.1.2.2.1. Institution ID *

5.1.2.2.2. Institution Name *

5.1.2.3.1. Institution name *

5.1.2.3.2. Institution address *

5.1.2.3.2.1. Street

5.1.2.3.2.2. Building Name

5.1.2.3.2.3. Town *

5.1.2.3.2.4. Postal Code

5.1.2.3.2.5. Region

5.1.2.3.2.6. Country *

5.1.Benefits claim details

6. Family members *

6.1. Family member *

6.1.1. Family member *

6.1.2. Identification of family member *

6.1.2.1. Person identification *

6.1.2.1.1. Family name(s) *

6.1.2.1.2. Forename(s) *

6.1.2.1.3. Date of birth *

6.1.2.1.4. Sex *

6.1.2.1.5. Family name(s) at birth

6.1.2.1.6. Forename(s) at birth

6.1.2.1.7. PIN of the person in each institution

6.1.2.1.7.1. Personal Identification Number(s) *

6.1.2.1.7.1.1. Country *

6.1.2.1.7.1.2. Personal Identification Number (PIN) *

6.1.2.1.7.1.3. Sector

6.1.2.1.7.1.4. Institution

6.1.2.1.7.1.4.1. Institution ID *

6.1.2.1.7.1.4.2. Institution Name *

6.1.2.1.7.1.Personal Identification Number(s)

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

6.1.2.1.8.1. Place of birth

6.1.2.1.8.1.1. Town *

6.1.2.1.8.1.2. Region

6.1.2.1.8.1.3. Country *

6.1.2.1.8.2. Father's family name at birth

6.1.2.1.8.3. Forename of father

6.1.2.1.8.4. Mother's family name at birth

6.1.2.1.8.5. Forename of mother

6.1.2.2. Additional information on the person

6.1.2.2.1. Nationality

6.1.3. Family member's address

6.1.3.1. Street

6.1.3.2. Building Name

6.1.3.3. Town *

6.1.3.4. Postal Code

6.1.3.5. Region

6.1.3.6. Country *

6.1.4. Please fill in the following if "Family member" = "03 - Child" :

6.1.4.1. Person taking care of child

6.1.4.1.1. Identification of person taking care of child *

6.1.4.1.1.1. Person identification *

6.1.4.1.1.1.1. Family name(s) *

6.1.4.1.1.1.2. Forename(s) *

6.1.4.1.1.1.3. Date of birth *

6.1.4.1.1.1.4. Sex *

6.1.4.1.1.1.5. Family name(s) at birth

6.1.4.1.1.1.6. Forename(s) at birth

6.1.4.1.1.1.7. PIN of the person in each institution

6.1.4.1.1.1.7.1. Personal Identification Number(s) *

6.1.4.1.1.1.7.1.1. Country *

6.1.4.1.1.1.7.1.2. Personal Identification Number (PIN) *

6.1.4.1.1.1.7.1.3. Sector

6.1.4.1.1.1.7.1.4. Institution

6.1.4.1.1.1.7.1.4.1. Institution ID *

6.1.4.1.1.1.7.1.4.2. Institution Name *

6.1.4.1.1.1.7.1.Personal Identification Number(s)

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

6.1.4.1.1.1.8.1. Place of birth

6.1.4.1.1.1.8.1.1. Town *

6.1.4.1.1.1.8.1.2. Region

6.1.4.1.1.1.8.1.3. Country *

6.1.4.1.1.1.8.2. Father's family name at birth

6.1.4.1.1.1.8.3. Forename of father

6.1.4.1.1.1.8.4. Mother's family name at birth

6.1.4.1.1.1.8.5. Forename of mother

6.1.4.1.1.2. Additional information on the person

6.1.4.1.1.2.1. Nationality

6.1.Family member

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U005 - Request Family Info Article 5 of Regulation (EC) No 883/2004; Article 54(3) of Regulation (EC) No 987/2009

U005 - Request Family Info
Article 5 of Regulation (EC) No 883/2004; Article 54(3) of Regulation (EC) No 987/2009