U029_Child

U029_Child - U029_Child

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

1. Individual claim *

1.1. Reimbursement request ID *

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1.2. Reimbursement contestation ID *

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1.3. Amended reimbursement request ID *

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1.4. Sequential number of Individual claim *

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1.5. Contested individual claim ID

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1.6. Amended contested individual claim ID *

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1.7. Individual claim status *

1.7.1. Status *

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

1.7.2.1. Reasoning

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1.8. Person *

1.8.1. Person identification *

1.8.1.1. Family name(s) *

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1.8.1.2. Forename(s) *

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1.8.1.3. Date of birth *

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1.8.1.4. Sex *

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1.8.1.5. Family name(s) at birth

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1.8.1.6. Forename(s) at birth

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1.8.1.7. PIN of the person in each institution

1.8.1.7.1. Personal Identification Number(s) *

1.8.1.7.1.1. Country *

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1.8.1.7.1.2. Personal Identification Number (PIN) *

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1.8.1.7.1.3. Sector

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1.8.1.7.1.4. Institution

1.8.1.7.1.4.1. Institution ID *

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1.8.1.7.1.4.2. Institution Name *

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1.8.1.7.1.Personal Identification Number(s)

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

1.8.1.8.1. Place of birth

1.8.1.8.1.1. Town *

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1.8.1.8.1.2. Region

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1.8.1.8.1.3. Country *

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1.8.1.8.2. Father's family name at birth

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1.8.1.8.3. Forename of father

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1.8.1.8.4. Mother's family name at birth

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1.8.1.8.5. Forename of mother

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1.8.2. Additional information on the person

1.8.2.1. Nationality

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1.9. Institution which certified insurance record *

1.9.1. Institution ID *

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1.9.2. Institution Name *

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1.10. Working periods considered *

1.10.1. Working period considered *

1.10.1.1. Start Date *

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1.10.1.2. End Date *

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1.10.1.Working period considered

1.11. Reimbursement period *

1.11.1. Start Date *

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1.11.2. End Date *

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1.12. Last payment date *

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1.13. Requested amount for reimbursement *

1.13.1. Amount *

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1.13.2. Currency *

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