DA018 - Information on Payment of Single Claim - Benefits in Kind (PAY)
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
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[ BDT ]

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Total Payment Amount to be paid* [ CC ]
Total Payment Amount to be refunded* [ CC ]


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{{$select.selected[ 'name']}}

[ ENUM ]


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{{$select.selected[ 'name']}}

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{{$select.selected[ 'name']}}

[ ENUM ]

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{{$select.selected[ 'name']}}

[ ENUM ]

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{{$select.selected[ 'name']}}

[ ENUM ]

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{{$select.selected[ 'name']}}

[ ENUM ]

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{{$select.selected[ 'name']}}

[ ENUM ]

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{{$select.selected[ 'name']}}

[ ENUM ]

[ BDT ]
[ SED ]

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[ CDT ]


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[ CDT ]


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[ ENUM ]

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[ BDT ]
{{$select.selected[ 'name']}}

[ ENUM ]

[ BDT ]
{{$select.selected[ 'name']}}

[ ENUM ]

[ BDT ]
{{$select.selected[ 'name']}}

[ ENUM ]

[ BDT ]

[ BDT ]

[ BDT ]

[ BDT ]
{{$select.selected[ 'name']}}

[ ENUM ]