Amended reimbursement request reacting to contestation

U029 - Amended reimbursement request reacting to contestation
Articles 65(6), 65(7) of Regulation (EC) No 883/2004, Article 70 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. General information *

2.1. Reimbursement request ID *

2.2. Reimbursement contestation ID *

2.3. Amended reimbursement request ID *

2.4. Updated total amount requested *

2.4.1. Amount *

2.4.2. Currency *

3. Individual claims *

3.1. Individual claim *

3.1.1. Reimbursement request ID *

3.1.2. Reimbursement contestation ID *

3.1.3. Amended reimbursement request ID *

3.1.4. Sequential number of Individual claim *

3.1.5. Contested individual claim ID

3.1.6. Amended contested individual claim ID *

3.1.7. Individual claim status *

3.1.7.1. Status *

3.1.7.2. Please fill in the following if "Status" = "06 - Under Dispute" :

3.1.7.2.1. Reasoning

3.1.8. Person *

3.1.8.1. Person identification *

3.1.8.1.1. Family name(s) *

3.1.8.1.2. Forename(s) *

3.1.8.1.3. Date of birth *

3.1.8.1.4. Sex *

3.1.8.1.5. Family name(s) at birth

3.1.8.1.6. Forename(s) at birth

3.1.8.1.7. PIN of the person in each institution

3.1.8.1.7.1. Personal Identification Number(s) *

3.1.8.1.7.1.1. Country *

3.1.8.1.7.1.2. Personal Identification Number (PIN) *

3.1.8.1.7.1.3. Sector

3.1.8.1.7.1.4. Institution

3.1.8.1.7.1.4.1. Institution ID *

3.1.8.1.7.1.4.2. Institution Name *

3.1.8.1.7.1.Personal Identification Number(s)

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

3.1.8.1.8.1. Place of birth

3.1.8.1.8.1.1. Town *

3.1.8.1.8.1.2. Region

3.1.8.1.8.1.3. Country *

3.1.8.1.8.2. Father's family name at birth

3.1.8.1.8.3. Forename of father

3.1.8.1.8.4. Mother's family name at birth

3.1.8.1.8.5. Forename of mother

3.1.8.2. Additional information on the person

3.1.8.2.1. Nationality

3.1.9. Institution which certified insurance record *

3.1.9.1. Institution ID *

3.1.9.2. Institution Name *

3.1.10. Working periods considered *

3.1.10.1. Working period considered *

3.1.10.1.1. Start Date *

3.1.10.1.2. End Date *

3.1.10.1.Working period considered

3.1.11. Reimbursement period *

3.1.11.1. Start Date *

3.1.11.2. End Date *

3.1.12. Last payment date *

3.1.13. Requested amount for reimbursement *

3.1.13.1. Amount *

3.1.13.2. Currency *

3.1.Individual claim

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U029 - Amended reimbursement request reacting to contestation Articles 65(6), 65(7) of Regulation (EC) No 883/2004, Article 70 of Regulation (EC) No 987/2009

U029 - Amended reimbursement request reacting to contestation
Articles 65(6), 65(7) of Regulation (EC) No 883/2004, Article 70 of Regulation (EC) No 987/2009