Circumstances likely to affect Entitlement

U010 - Circumstances likely to affect Entitlement - Export
Article 64, 65(5)(b), 65a(3) of Regulation (EC) No 883/2004; Article 55 (4), 55(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 *

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. Circumstance *

3.1. Period *

Fixed period*
Open period*

3.1.1.1. Start date *

3.1.1.2. End date *

3.1.2.1. Type of Open Period *

3.1.2.2. Start date *

3.2. Circumstances *

3.3. Please fill in the following if "Circumstances" = "99 - Other circumstances" :

3.3.1. Other circumstance specification

3.3.1.1. Circumstance *

3.3.1.Other circumstance specification

4. Follow up requested *

4.1. Follow up requested *

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U010 - Circumstances likely to affect Entitlement - Export Article 64, 65(5)(b), 65a(3) of Regulation (EC) No 883/2004; Article 55 (4), 55(5) of Regulation (EC) No 987/2009

U010 - Circumstances likely to affect Entitlement - Export
Article 64, 65(5)(b), 65a(3) of Regulation (EC) No 883/2004; Article 55 (4), 55(5) of Regulation (EC) No 987/2009