U023_Child

U023_Child - U023_Child

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

1. Individual Claim Contested *

1.1. Reimbursement request ID *

1.2. Reimbursement contestation ID *

1.3. Sequential number of Individual claim *

1.4. Contested individual claim ID *

1.5. Person *

1.5.1. Family name(s) *

1.5.2. Forename(s) *

1.5.3. Date of birth *

1.5.4. Sex *

1.6. Contestation type *

Non-acceptance of the individual claim*
Partial acceptance of the individual claim*

1.6.1.1. Reason for non-acceptance *

1.6.1.2. Please fill in the following if "Reason for non-acceptance" = "03 - Other reason or additional information" :

1.6.1.2.1. Information about other reason or additional information

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1.6.2.1. Reason for partial non-acceptance *

1.6.2.2. Please fill in the following if "Reason for partial non acceptance" = "01 - Partial acceptance due to ceiling under national law" :

1.6.2.2.1. Amount intended to be reimbursed *

1.6.2.2.1.1. Amount *

1.6.2.2.1.2. Currency *

1.6.2.3. Please fill in the following if "Reason for partial non acceptance" = "03 - Reimbursement claim incomplete" :

1.6.2.3.1. Information on missing data

1.6.2.4. Please fill in the following if "Reason for partial non acceptance" = "04 - Other reason or additional information" :

1.6.2.4.1. Additional information

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