Request for Exception

A001 - Request for Exception
Article 16 (1) of Regulation (EC) No 883/2004, Article 18 of Regulation(EC) No 987/2009

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Person * [ SC ]

1.1. Person Identification * [ CC ]

1.1.1. Family name(s) *

[ BDT ] {{metaSection.familyName.$$error}} {{metaSection.familyName.$$warning}}

1.1.2. Forename(s) *

[ BDT ] {{metaSection.forename.$$error}} {{metaSection.forename.$$warning}}

1.1.3. Date of birth *

[ BDT ] {{metaSection.dateBirth.$$error}} {{metaSection.dateBirth.$$warning}}

1.1.4. Sex *

[ ENUM ] {{metaSection.sex.$$error}} {{metaSection.sex.$$warning}}

1.1.5. Family name(s) at birth

[ BDT ] {{metaSection.familyNameAtBirth.$$error}} {{metaSection.familyNameAtBirth.$$warning}}

1.1.6. Forename(s) at birth

[ BDT ] {{metaSection.forenameAtBirth.$$error}} {{metaSection.forenameAtBirth.$$warning}}

1.1.7. PIN of the person in each institution

[ CC ]

1.1.7.1. Personal Identification Number(s) * [ CC ]

1.1.7.1.1. Country *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

1.1.7.1.2. Personal Identification Number (PIN) *

[ BDT ] {{metaSection.personalIdentificationNumber.$$error}} {{metaSection.personalIdentificationNumber.$$warning}}

1.1.7.1.3. Sector

[ ENUM ] {{metaSection.sector.$$error}} {{metaSection.sector.$$warning}}

1.1.7.1.4. Institution

[ CC ]

1.1.7.1.4.1. Institution ID *

[ BDT ] {{metaSection.institutionID.$$error}} {{metaSection.institutionID.$$warning}}

1.1.7.1.4.2. Institution Name *

[ CDT ] {{metaSection.institutionName.$$error}} {{metaSection.institutionName.$$warning}}

1.1.7.1.Personal Identification Number(s)

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

[ CC ]

1.1.8.1. Place of birth

[ CC ]

1.1.8.1.1. Town *

[ CDT ] {{metaSection.town.$$error}} {{metaSection.town.$$warning}}

1.1.8.1.2. Region

[ CDT ] {{metaSection.region.$$error}} {{metaSection.region.$$warning}}

1.1.8.1.3. Country *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

1.1.8.2. Father's family name at birth

[ BDT ] {{metaSection.fatherFamilyNameAtBirth.$$error}} {{metaSection.fatherFamilyNameAtBirth.$$warning}}

1.1.8.3. Forename of father

[ BDT ] {{metaSection.forenameFather.$$error}} {{metaSection.forenameFather.$$warning}}

1.1.8.4. Mother's family name at birth

[ BDT ] {{metaSection.motherFamilyNameAtBirth.$$error}} {{metaSection.motherFamilyNameAtBirth.$$warning}}

1.1.8.5. Forename of mother

[ BDT ] {{metaSection.forenameMother.$$error}} {{metaSection.forenameMother.$$warning}}

1.2. Additional information on the person * [ SC ]

1.2.1. Nationality *

[ ENUM ] {{metaSection.nationality.$$error}} {{metaSection.nationality.$$warning}}

2. Addresses * [ SC ]

2.1. Address * [ SC ]

2.1.1. Type *

[ ENUM ] {{metaSection.type.$$error}} {{metaSection.type.$$warning}}

2.1.2. Address *

[ CC ]

2.1.2.1. Street

[ CDT ] {{metaSection.street.$$error}} {{metaSection.street.$$warning}}

2.1.2.2. Building Name

[ CDT ] {{metaSection.buildingName.$$error}} {{metaSection.buildingName.$$warning}}

2.1.2.3. Town *

[ CDT ] {{metaSection.town.$$error}} {{metaSection.town.$$warning}}

2.1.2.4. Postal Code

[ CDT ] {{metaSection.postalCode.$$error}} {{metaSection.postalCode.$$warning}}

2.1.2.5. Region

[ CDT ] {{metaSection.region.$$error}} {{metaSection.region.$$warning}}

2.1.2.6. Country *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

2.1.Address

3. Identification of the employer(s) [ SC ]

3.1. Employer

[ CC ]

3.1.1. Name *

[ CDT ] {{metaSection.name.$$error}} {{metaSection.name.$$warning}}

3.1.2. Identification numbers

[ CC ]

3.1.2.1. Identification number

[ CC ]

3.1.2.1.1. Number *

[ CDT ] {{metaSection.number.$$error}} {{metaSection.number.$$warning}}

3.1.2.1.2. Type *

[ ENUM ] {{metaSection.type.$$error}} {{metaSection.type.$$warning}}

3.1.2.1.Identification number

3.1.3. Address

[ CC ]

3.1.3.1. Street

[ CDT ] {{metaSection.street.$$error}} {{metaSection.street.$$warning}}

3.1.3.2. Building Name

[ CDT ] {{metaSection.buildingName.$$error}} {{metaSection.buildingName.$$warning}}

3.1.3.3. Town *

[ CDT ] {{metaSection.town.$$error}} {{metaSection.town.$$warning}}

3.1.3.4. Postal Code

[ CDT ] {{metaSection.postalCode.$$error}} {{metaSection.postalCode.$$warning}}

3.1.3.5. Region

[ CDT ] {{metaSection.region.$$error}} {{metaSection.region.$$warning}}

3.1.3.6. Country *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

3.1.Employer

4. Identification of the self-employment(s) [ SC ]

4.1. Self-Employment

[ CC ]

4.1.1. Name *

[ CDT ] {{metaSection.name.$$error}} {{metaSection.name.$$warning}}

4.1.2. Identification numbers

[ CC ]

4.1.2.1. Identification number

[ CC ]

4.1.2.1.1. Number *

[ CDT ] {{metaSection.number.$$error}} {{metaSection.number.$$warning}}

4.1.2.1.2. Type *

[ ENUM ] {{metaSection.type.$$error}} {{metaSection.type.$$warning}}

4.1.2.1.Identification number

4.1.3. Address

[ CC ]

4.1.3.1. Street

[ CDT ] {{metaSection.street.$$error}} {{metaSection.street.$$warning}}

4.1.3.2. Building Name

[ CDT ] {{metaSection.buildingName.$$error}} {{metaSection.buildingName.$$warning}}

4.1.3.3. Town *

[ CDT ] {{metaSection.town.$$error}} {{metaSection.town.$$warning}}

4.1.3.4. Postal Code

[ CDT ] {{metaSection.postalCode.$$error}} {{metaSection.postalCode.$$warning}}

4.1.3.5. Region

[ CDT ] {{metaSection.region.$$error}} {{metaSection.region.$$warning}}

4.1.3.6. Country *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

4.1.Self-Employment

5. Place(s) of work [ SC ]

5.1. Place of Work [ SC ]

5.1.1. Company name / vessel name *

[ CDT ] {{metaSection.companyNameVesselName.$$error}} {{metaSection.companyNameVesselName.$$warning}}

5.1.2. Flag state/home base

[ CDT ] {{metaSection.flagStateHomeBase.$$error}} {{metaSection.flagStateHomeBase.$$warning}}

5.1.3. Address *

[ CC ]

5.1.3.1. Street

[ CDT ] {{metaSection.street.$$error}} {{metaSection.street.$$warning}}

5.1.3.2. Building Name

[ CDT ] {{metaSection.buildingName.$$error}} {{metaSection.buildingName.$$warning}}

5.1.3.3. Town *

[ CDT ] {{metaSection.town.$$error}} {{metaSection.town.$$warning}}

5.1.3.4. Postal Code

[ CDT ] {{metaSection.postalCode.$$error}} {{metaSection.postalCode.$$warning}}

5.1.3.5. Region

[ CDT ] {{metaSection.region.$$error}} {{metaSection.region.$$warning}}

5.1.3.6. Country *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

5.1.4. No fixed address in State(s) of work

[ ENUM ] {{metaSection.noFixedAddressInStateWorkIndicator.$$error}} {{metaSection.noFixedAddressInStateWorkIndicator.$$warning}}

5.1.Place of Work

6. Employer in the Host Country (if relevant)

[ CC ]

6.1. Name *

[ CDT ] {{metaSection.name.$$error}} {{metaSection.name.$$warning}}

6.2. Identification numbers

[ CC ]

6.2.1. Identification number

[ CC ]

6.2.1.1. Number *

[ CDT ] {{metaSection.number.$$error}} {{metaSection.number.$$warning}}

6.2.1.2. Type *

[ ENUM ] {{metaSection.type.$$error}} {{metaSection.type.$$warning}}

6.2.1.Identification number

6.3. Address

[ CC ]

6.3.1. Street

[ CDT ] {{metaSection.street.$$error}} {{metaSection.street.$$warning}}

6.3.2. Building Name

[ CDT ] {{metaSection.buildingName.$$error}} {{metaSection.buildingName.$$warning}}

6.3.3. Town *

[ CDT ] {{metaSection.town.$$error}} {{metaSection.town.$$warning}}

6.3.4. Postal Code

[ CDT ] {{metaSection.postalCode.$$error}} {{metaSection.postalCode.$$warning}}

6.3.5. Region

[ CDT ] {{metaSection.region.$$error}} {{metaSection.region.$$warning}}

6.3.6. Country *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

7. Requested period *

[ CC ]

7.1. Start Date *

[ BDT ] {{metaSection.startDate.$$error}} {{metaSection.startDate.$$warning}}

7.2. End Date *

[ BDT ] {{metaSection.endDate.$$error}} {{metaSection.endDate.$$warning}}

8. Articles of Basic Regulation referring to situation for which agreement on exception is proposed * [ SED ]

8.1. Articles of Basic Regulation referring to situation for which agreement on exception is proposed *

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8.2. Other

[ CDT ] {{metaSection.other.$$error}} {{metaSection.other.$$warning}}

9. Applicable legislation * [ SED ]

9.1. Applicable legislation - current situation *

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9.2. Applicable legislation - requested situation *

[ ENUM ] {{metaSection.applicableLegislationRequestedSituation.$$error}} {{metaSection.applicableLegislationRequestedSituation.$$warning}}

10. More information [ SED ]

10.1. Type of request [ SED ]

10.1.1. Amendment

[ ENUM ] {{metaSection.amendmentIndicator.$$error}} {{metaSection.amendmentIndicator.$$warning}}

10.2. Dates of previous request [ SED ]

10.2.1. Date of previous request [ SED ]

10.2.1.1. Date

[ BDT ] {{metaSection.date.$$error}} {{metaSection.date.$$warning}}

10.2.1.Date of previous request

10.3. Previous periods [ SED ]

10.3.1. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.3.1.1.1. Start date *

[ BDT ] {{metaSection.startDate.$$error}} {{metaSection.startDate.$$warning}}

10.3.1.1.2. End date *

[ BDT ] {{metaSection.endDate.$$error}} {{metaSection.endDate.$$warning}}

10.3.1.2.1. Type of Open Period *

[ ENUM ] {{metaSection.typeOpenPeriod.$$error}} {{metaSection.typeOpenPeriod.$$warning}}

10.3.1.2.2. Start date *

[ BDT ] {{metaSection.startDate.$$error}} {{metaSection.startDate.$$warning}}

10.3.1.Period

10.4. PD A1 issued on basis of article

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10.5. Special circumstances

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10.6. Description of the other situation

[ CDT ] {{metaSection.descriptionOtherSituation.$$error}} {{metaSection.descriptionOtherSituation.$$warning}}

10.7. Date on which contract with sending employer started

[ BDT ] {{metaSection.dateWhichContractWithSendingEmployerStarted.$$error}} {{metaSection.dateWhichContractWithSendingEmployerStarted.$$warning}}

10.8. Date on which employee was first insured in sending country

[ BDT ] {{metaSection.dateWhichEmployeeFirstInsuredInSendingCountry.$$error}} {{metaSection.dateWhichEmployeeFirstInsuredInSendingCountry.$$warning}}

10.9. Justification

[ CDT ] {{metaSection.justification.$$error}} {{metaSection.justification.$$warning}}

11. Additional information

[ SC ]

11.1. Additional information

[ CDT ] {{metaSection.additionalInformation.$$error}} {{metaSection.additionalInformation.$$warning}}

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A001 - Request for Exception Article 16 (1) of Regulation (EC) No 883/2004, Article 18 of Regulation(EC) No 987/2009

A001 - Request for Exception
Article 16 (1) of Regulation (EC) No 883/2004, Article 18 of Regulation(EC) No 987/2009