Insurance Record - Cross border Worker

U017 - Insurance Record - Cross border Worker
Articles 61, 65 of Regulation (EC) No 883/2004; Article 54(1) of Regulation (EC) No 987/2009

SED API version: 0.14.2 PREVIEW build 3
Model version: 4.0.16

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. Reference period *

Fixed period*
Open period*

3.1.1. Start date *

3.1.2. End date *

3.2.1. Type of Open Period *

3.2.2. Start date *

4. Entitled to benefits *

4.1. Entitled? *

Please fill in the following if "Entitled?" = "Yes" :
Please fill in the following if "Entitled?" = "No" :

4.2.1. Article number

4.2.2. Entitlement period

Fixed period*
Open period*

4.2.2.1.1. Start date *

4.2.2.1.2. End date *

4.2.2.2.1. Type of Open Period *

4.2.2.2.2. Start date *

4.3.1. Reason

5. Periods of insurance, employment or self employment

5.1. Period of insurance, employment or self employment

5.1.1. Period *

Fixed period*
Open period*

5.1.1.1.1. Start date *

5.1.1.1.2. End date *

5.1.1.2.1. Type of Open Period *

5.1.1.2.2. Start date *

5.1.2. Type of period *

Please fill in the following if "Type of period" = "01 - Employment that is insurance period" or "Type of period" = "02 - Self employment that is insurance period" :
Please fill in the following if "Type of period" = "03 - Employment that is not insurance period" or "Type of period" = "04 - Self employment that is not insurance period" :
Please fill in the following if "Type of period" = "10 - Other period that is insurance period or treated as insurance period" :

5.1.3.1. Employer or self employment details

5.1.3.1.1. Name *

5.1.3.1.2. Identification numbers

5.1.3.1.2.1. Identification number

5.1.3.1.2.1.1. Number *

5.1.3.1.2.1.2. Type *

5.1.3.1.2.1.Identification number

5.1.3.1.3. Address

5.1.3.1.3.1. Street

5.1.3.1.3.2. Building Name

5.1.3.1.3.3. Town *

5.1.3.1.3.4. Postal Code

5.1.3.1.3.5. Region

5.1.3.1.3.6. Country *

5.1.4.1. Requested additional details

5.1.4.1.1. Earnings and or hours

5.1.4.1.1.1. Earnings and or hours

5.1.4.1.1.1.1. Period *

Fixed period*
Open period*

5.1.4.1.1.1.1.1.1. Start date *

5.1.4.1.1.1.1.1.2. End date *

5.1.4.1.1.1.1.2.1. Type of Open Period *

5.1.4.1.1.1.1.2.2. Start date *

5.1.4.1.1.1.2. Gross earnings

5.1.4.1.1.1.2.1. Amount *

5.1.4.1.1.1.2.2. Currency *

5.1.4.1.1.1.3. Number of working hours

5.1.4.1.1.1.Earnings and or hours

5.1.4.1.2. Employment or self employment nature

5.1.4.2. Employer or Self employment details

5.1.4.2.1. Name *

5.1.4.2.2. Identification numbers

5.1.4.2.2.1. Identification number

5.1.4.2.2.1.1. Number *

5.1.4.2.2.1.2. Type *

5.1.4.2.2.1.Identification number

5.1.4.2.3. Address

5.1.4.2.3.1. Street

5.1.4.2.3.2. Building Name

5.1.4.2.3.3. Town *

5.1.4.2.3.4. Postal Code

5.1.4.2.3.5. Region

5.1.4.2.3.6. Country *

5.1.5.1. Type

Please fill in the following if "Type" = "02 - Other period treated as a period of insurance" :
Please fill in the following if "Type" = "03 - Compensation for vacation not taken" :

5.1.5.2.1. Type of 'Other period treated as a period of insurance'

5.1.5.3.1. Vacation not taken

5.1.5.3.1.1. Amount *

5.1.5.3.1.1.1. Amount *

5.1.5.3.1.1.2. Currency *

5.1.Period of insurance, employment or self employment

6. Elements concerning the last employment or self employment important for starting date of benefits

6.1. Type of amounts

6.1.1. Type of amount

6.1.1.1. Type of amount

6.1.1.2. Payment *

6.1.1.2.1. Amount *

6.1.1.2.2. Currency *

Please fill in the following if "Type of amount" = "01 - Wages for period after termination of employment or self employment" :
Please fill in the following if "Type of amount" = "02 - Compensation for vacation not taken (Annual leave)" :

6.1.2.1. Received for period until

6.1.3.1. Number of days

6.1.Type of amounts

6.2. Waived rights

6.2.1. Waived rights

6.2.2. Reason

6.3. Other benefit(s)

7. Reason for termination of the last employment or self employment

7.1. Termination reason of employment

7.2. Please fill in the following if "Termination reason of employment" = "08 - Other" :

7.2.1. Other termination

7.3. Termination reason of self employment

8. Unemployment benefits periods

8.1. Unemployment benefits period

8.1.1. Period *

Fixed period*
Open period*

8.1.1.1.1. Start date *

8.1.1.1.2. End date *

8.1.1.2.1. Type of Open Period *

8.1.1.2.2. Start date *

8.1.2. Local institution

8.1.2.1. 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" :

8.1.2.2.1. Institution ID *

8.1.2.2.2. Institution Name *

8.1.2.3.1. Institution name *

8.1.2.3.2. Institution address *

8.1.2.3.2.1. Street

8.1.2.3.2.2. Building Name

8.1.2.3.2.3. Town *

8.1.2.3.2.4. Postal Code

8.1.2.3.2.5. Region

8.1.2.3.2.6. Country *

8.1.Unemployment benefits period

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U017 - Insurance Record - Cross border Worker Articles 61, 65 of Regulation (EC) No 883/2004; Article 54(1) of Regulation (EC) No 987/2009

U017 - Insurance Record - Cross border Worker
Articles 61, 65 of Regulation (EC) No 883/2004; Article 54(1) of Regulation (EC) No 987/2009