Credit Note - Benefits in Kind (CRN)

DA012 - Credit Note - Benefits in Kind (CRN)
Articles 35, 41 of Regulation (EC) No 883/2004, 62, 66 (1), 67 of Regulation (EC) No 987/2009

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Global Note CRN * [ SED ]

1.1. Global CLA reference Creditor Liaison Body *

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1.2. Global CRN reference Creditor Liaison Body *

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1.3. Total number of Individual Credit notes

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1.4. Total Amount Of Credit Notes * [ CC ]

1.4.1. Amount *

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1.4.2. Currency *

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1.5. Date Of Submission *

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2. Individual CRNs * [ SED ]

2.1. Individual CRN * [ SED ]

2.1.1. ID Creditor Institution * [ CC ]

2.1.1.1. Institution ID *

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2.1.1.2. Institution Name *

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2.1.2. ID Debtor Institution * [ CC ]

2.1.2.1. Institution ID *

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2.1.2.2. Institution Name *

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2.1.3. References * [ SED ]

2.1.3.1. Global CLA Reference Creditor Liaison Body *

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2.1.3.2. Global CRN Reference Creditor Liaison Body *

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2.1.3.3. Individual CLA Number Creditor Liaison Body *

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2.1.3.4. Individual CRN Number Creditor Liaison Body *

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2.1.4. Person receiving benefits * [ CC ]

2.1.4.1. Person Information * [ CC ]

2.1.4.1.1. Family name(s) *

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2.1.4.1.2. Forename(s) *

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2.1.4.1.3. Date of birth *

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2.1.4.1.4. Sex *

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2.1.4.2. Family name(s) at birth

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2.1.4.3. Forename(s) at birth

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2.1.4.4. Person Identification Number * [ CC ]

2.1.4.4.1. PIN of the person in Competent Member State *

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2.1.4.4.2. PIN of the person in Member State of Stay or Residence

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2.1.5. Credit Note Benefits * [ SC ]

2.1.5.1. Benefit related to *

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2.1.5.2. Date *

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

2.1.5.3. Benefits Period * [ CC ]

2.1.5.3.1. Start Date *

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2.1.5.3.2. End Date *

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2.1.5.4. Detailed benefits amount * [ SC ]

2.1.5.4.1. Medical Care Amount

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2.1.5.4.2. Medicine Amount

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2.1.5.4.3. Dental Care Amount

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2.1.5.4.4. Long-term Care Amount

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2.1.5.4.5. Hospitalisation Benefits [ SC ]

2.1.5.4.5.1. Hospitalisation benefit [ SC ]

2.1.5.4.5.1.1. Hospitalisation period [ CC ]

2.1.5.4.5.1.1.1. Start Date *

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2.1.5.4.5.1.1.2. End Date *

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2.1.5.4.5.1.2. Hospitalisation Amount *

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2.1.5.4.5.1.Hospitalisation benefit

2.1.5.4.6. Other benefit(s) [ SC ]

2.1.5.4.6.1. Other benefit [ SC ]

2.1.5.4.6.1.1. Other Benefit Description *

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2.1.5.4.6.1.2. Other Benefits Amount *

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

2.1.5.4.6.1.Other benefit

2.1.6. Total Amount of Individual CRN * [ CC ]

2.1.6.1. Amount *

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2.1.6.2. Currency *

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2.1.Individual CRN

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DA012 - Credit Note - Benefits in Kind (CRN) Articles 35, 41 of Regulation (EC) No 883/2004, 62, 66 (1), 67 of Regulation (EC) No 987/2009

DA012 - Credit Note - Benefits in Kind (CRN)
Articles 35, 41 of Regulation (EC) No 883/2004, 62, 66 (1), 67 of Regulation (EC) No 987/2009