Reply for determining competence

F002 - Reply for determining competence
Articles 1 (i), 11, 67, 68 of Regulation (EC) No 883/2004; Articles 2(2), 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(4), 60(5), 72, 73, 74 of Regulation (EC) No 987/2009

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Purpose of this SED

[ SED ]

1.1. Purpose of this SED

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

2. Receipt of application for family benefits

[ SC ]

2.1. Date of receipt of the application

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

2.2. Request for period of information [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

2.2.1.1. Start date *

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

2.2.1.2. End date *

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

2.2.2.1. Type of Open Period *

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

2.2.2.2. Start date *

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

2.2.Request for period of information

2.3. Type of claim

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

2.4. Information on application

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

2.5. Points for which more information is needed

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

3. Information about change in circumstances

[ SC ]

3.1. Change of Circumstance for

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

4. Additional request or information

[ SC ]

4.1. Additional information

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

5. Decision

[ SC ]

Decision regarding all children mentioned in this SED [ ENUM ]

Decision which does not concern all children mentioned in this SED [ SC ]

5.1. Decision regarding all children mentioned in this SED

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

5.2.1. Decision regarding all children mentioned in this SED

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

5.2.2. Child for whom this decision applies [ SC ]

5.2.2.1. Family Name *

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

5.2.2.2. Forename *

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

5.2.2.3. Date of Birth *

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

5.2.2.Child for whom this decision applies

5.3. Periods [ SC ]

5.3.1. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

5.3.1.1.1. Start date *

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

5.3.1.1.2. End date *

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

5.3.1.2.1. Type of Open Period *

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

5.3.1.2.2. Start date *

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

5.3.1.Period

5.4. Type of decision

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

5.5. The reason for decision

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

5.6. Additional information

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

5.7. Decisions on primary competence with article 68 of Regulation (EC) No 883/2004 [ SC ]

5.7.1. Decision [ SC ]

5.7.1.1. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

5.7.1.1.1.1. Start date *

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

5.7.1.1.1.2. End date *

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

5.7.1.1.2.1. Type of Open Period *

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

5.7.1.1.2.2. Start date *

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

5.7.1.2. Payment of benefit

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

5.7.1.Decision

5.8. Decision on secondary competence with article 68 of Regulation (EC) No 883/2004 [ SC ]

5.8.1. Decision [ SC ]

5.8.1.1. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

5.8.1.1.1.1. Start date *

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

5.8.1.1.1.2. End date *

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

5.8.1.1.2.1. Type of Open Period *

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

5.8.1.1.2.2. Start date *

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

5.8.1.2. Payment of benefit

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

5.8.1.Decision

5.9. Decision on primary competence with article 58 of Regulation (EC) No 987/2009 [ SC ]

5.9.1. Decision [ SC ]

5.9.1.1. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

5.9.1.1.1.1. Start date *

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

5.9.1.1.1.2. End date *

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

5.9.1.1.2.1. Type of Open Period *

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

5.9.1.1.2.2. Start date *

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

5.9.1.Decision

5.10. Decision on secondary competence with article 58 of Regulation (EC) No 987/2009 [ SC ]

5.10.1. Decision [ SC ]

5.10.1.1. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

5.10.1.1.1.1. Start date *

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

5.10.1.1.1.2. End date *

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

5.10.1.1.2.1. Type of Open Period *

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

5.10.1.1.2.2. Start date *

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

5.10.1.Decision

5.11. Content of decision

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

5.12. Date of decision

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

6. Reason for disagreement

[ SC ]

6.1. Employment/self-employment period/status

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

6.2. Period of pension received

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

6.3. Insurance period

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

6.4. Duration on territory

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

6.5. Residence of child(ren)

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

6.6. Personal situation elements (article 11 of Regulation (EC) No 987/2009)

[ ENUM ] {{metaSection.personalSituationElementsArt11RegulationECNo9872009.$$error}} {{metaSection.personalSituationElementsArt11RegulationECNo9872009.$$warning}}

6.7. Additional grounds for disagreement

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

7. Information on agreement/disagreement after communication

[ SED ]

7.1. Information of agreement with decision [ SED ]

7.1.1. Decision dated

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

7.1.2. Additional information of disagreement with decision

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

7.1.3. In case of disagreement [ SED ]

7.1.3.1. The case will be taken to the Administrative Commission

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

7.1.3.2. Additional information for grounds of disagreement

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

7.1.Information of agreement with decision

8. Claimant *

[ SC ]

8.1. Person Identification * [ CC ]

8.1.1. Family name(s) *

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

8.1.2. Forename(s) *

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

8.1.3. Date of birth *

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

8.1.4. Sex *

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

8.1.5. Family name(s) at birth

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

8.1.6. Forename(s) at birth

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

8.1.7. PIN of the person in each institution

[ CC ]

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

8.1.7.1.1. Country *

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

8.1.7.1.2. Personal Identification Number (PIN) *

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

8.1.7.1.3. Sector

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

8.1.7.1.4. Institution

[ CC ]

8.1.7.1.4.1. Institution ID *

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

8.1.7.1.4.2. Institution Name *

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

8.1.7.1.Personal Identification Number(s)

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

[ CC ]

8.1.8.1. Place of birth

[ CC ]

8.1.8.1.1. Town *

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

8.1.8.1.2. Region

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

8.1.8.1.3. Country *

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

8.1.8.2. Father's family name at birth

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

8.1.8.3. Forename of father

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

8.1.8.4. Mother's family name at birth

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

8.1.8.5. Forename of mother

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

8.2. Additional information about nationality [ SC ]

8.2.1. Nationalities [ SC ]

8.2.1.1. Nationality *

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

8.2.1.2. Since

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

8.2.1.Nationalities

8.3. Addresses of the person

[ SC ]

8.3.1. Address of the Person

[ SC ]

8.3.1.1. Type of address

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

8.3.1.2. Address

[ CC ]

8.3.1.2.1. Street

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

8.3.1.2.2. Building Name

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

8.3.1.2.3. Town *

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

8.3.1.2.4. Postal Code

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

8.3.1.2.5. Region

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

8.3.1.2.6. Country *

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

8.3.1.Address of the Person

8.4. Contact Details [ CC ]

8.4.1. Telephone Numbers [ CC ]

8.4.1.1. Telephone Number [ CC ]

8.4.1.1.1. Type

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

8.4.1.1.2. Number *

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

8.4.1.1.Telephone Number

8.4.2. Email Addresses [ CC ]

8.4.2.1. Email Address [ CC ]

8.4.2.1.1. Email Address

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

8.4.2.1.Email Address

8.5. Coverage by social security scheme [ SC ]

8.5.1. Periods Covered by security scheme in sending Member State

[ SC ]

8.5.1.1. Period

[ CC ]

8.5.1.1.1. Start Date *

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

8.5.1.1.2. End Date *

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

8.5.1.1.Period

8.5.2. Periods Not covered [ SC ]

8.5.2.1. Period Not Covered

[ CC ]

8.5.2.1.1. Start Date *

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

8.5.2.1.2. End Date *

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

8.5.2.1.Period Not Covered

8.5.3. Periods of Entitlement [ SC ]

Entitlement to Family Benefits, if yes [ SC ]

If no entitlement, choose one reason [ SC ]

8.5.3.1.1. Period Entitlement Family Benefits [ SC ]

8.5.3.1.1.1. Period of Entitlement to family benefit

[ CC ]

8.5.3.1.1.1.1. Start Date *

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

8.5.3.1.1.1.2. End Date *

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

8.5.3.1.1.1.Period of Entitlement to family benefit

8.5.3.2.1. Reason

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

8.5.3.2.2. Other reason

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

8.6. Family relationship of the claimant to spouse or other person [ SC ]

8.6.1. Relationships [ SC ]

8.6.1.1. Family relationship

[ SC ]

8.6.1.1.1. Family Relationship

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

8.6.1.1.2. Other

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

8.6.1.1.3. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

8.6.1.1.3.1.1. Start date *

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

8.6.1.1.3.1.2. End date *

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

8.6.1.1.3.2.1. Type of Open Period *

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

8.6.1.1.3.2.2. Start date *

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

8.6.1.1.4. Other relationship

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

8.6.1.1.5. Name of person

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

8.6.1.1.6. Date of relationship

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

8.6.1.1.7. Was the claimant a member of the same household as the person in question

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

8.6.1.1.Family relationship

8.7. Status of the person [ SC ]

Person is regarded as an active person [ SC ]

Person is regarded as a non-active person [ SC ]

No information about activity of person [ SC ]

8.7.1.1. Type of Employment *

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

8.7.1.2. Periods of Employment *

[ SC ]

8.7.1.2.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

8.7.1.2.1.1.1. Start date *

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

8.7.1.2.1.1.2. End date *

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

8.7.1.2.1.2.1. Type of Open Period *

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

8.7.1.2.1.2.2. Start date *

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

8.7.1.2.1.Period

8.7.2.1. Type of non-Active Person *

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

8.7.2.2. Periods of Non Activity * [ SC ]

8.7.2.2.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

8.7.2.2.1.1.1. Start date *

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

8.7.2.2.1.1.2. End date *

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

8.7.2.2.1.2.1. Type of Open Period *

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

8.7.2.2.1.2.2. Start date *

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

8.7.2.2.1.Period

8.7.3.1. Periods of Non Activity * [ SC ]

8.7.3.1.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

8.7.3.1.1.1.1. Start date *

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

8.7.3.1.1.1.2. End date *

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

8.7.3.1.1.2.1. Type of Open Period *

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

8.7.3.1.1.2.2. Start date *

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

8.7.3.1.1.Period

8.7.3.2. Additional Information

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

8.7.4. Employment Periods

[ SC ]

8.7.4.1. Employment period

[ CC ]

8.7.4.1.1. Start Date *

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

8.7.4.1.2. End Date *

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

8.7.4.1.Employment period

8.7.5. Additional information

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

8.7.6. Periods of pension received in sending Member State

[ SC ]

8.7.6.1. Period of pension received in sending Member State [ SC ]

8.7.6.1.1. Type of pension

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

8.7.6.1.2. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

8.7.6.1.2.1.1. Start date *

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

8.7.6.1.2.1.2. End date *

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

8.7.6.1.2.2.1. Type of Open Period *

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

8.7.6.1.2.2.2. Start date *

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

8.7.6.1.Period of pension received in sending Member State

8.7.7. Insurance periods in sending Member State

[ SC ]

8.7.7.1. Insurance Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

8.7.7.1.1.1. Start date *

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

8.7.7.1.1.2. End date *

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

8.7.7.1.2.1. Type of Open Period *

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

8.7.7.1.2.2. Start date *

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

8.7.7.1.Insurance Period

8.7.8. Grounds for residence [ SC ]

8.7.8.1. Durations on territory

[ SC ]

8.7.8.1.1. Duration on territory [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

8.7.8.1.1.1.1. Start date *

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

8.7.8.1.1.1.2. End date *

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

8.7.8.1.1.2.1. Type of Open Period *

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

8.7.8.1.1.2.2. Start date *

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

8.7.8.1.1.Duration on territory

8.7.8.2. Moving date into sending Member State

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

8.7.8.3. Moving date into receiving Member State

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

8.7.8.4. Personal situation elements (article 11 of Regulation (EC) No 987/2009)

[ CDT ] {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$error}} {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$warning}}

9. Information on spouse or partner

[ SC ]

9.1. Person Identification * [ CC ]

9.1.1. Family name(s) *

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

9.1.2. Forename(s) *

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

9.1.3. Date of birth *

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

9.1.4. Sex *

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

9.1.5. Family name(s) at birth

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

9.1.6. Forename(s) at birth

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

9.1.7. PIN of the person in each institution

[ CC ]

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

9.1.7.1.1. Country *

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

9.1.7.1.2. Personal Identification Number (PIN) *

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

9.1.7.1.3. Sector

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

9.1.7.1.4. Institution

[ CC ]

9.1.7.1.4.1. Institution ID *

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

9.1.7.1.4.2. Institution Name *

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

9.1.7.1.Personal Identification Number(s)

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

[ CC ]

9.1.8.1. Place of birth

[ CC ]

9.1.8.1.1. Town *

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

9.1.8.1.2. Region

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

9.1.8.1.3. Country *

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

9.1.8.2. Father's family name at birth

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

9.1.8.3. Forename of father

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

9.1.8.4. Mother's family name at birth

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

9.1.8.5. Forename of mother

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

9.2. Additional information about nationality [ SC ]

9.2.1. Nationalities [ SC ]

9.2.1.1. Nationality *

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

9.2.1.2. Since

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

9.2.1.Nationalities

9.3. Addresses of the person

[ SC ]

9.3.1. Address of the Person

[ SC ]

9.3.1.1. Type of address

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

9.3.1.2. Address

[ CC ]

9.3.1.2.1. Street

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

9.3.1.2.2. Building Name

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

9.3.1.2.3. Town *

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

9.3.1.2.4. Postal Code

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

9.3.1.2.5. Region

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

9.3.1.2.6. Country *

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

9.3.1.Address of the Person

9.4. Contact Details [ CC ]

9.4.1. Telephone Numbers [ CC ]

9.4.1.1. Telephone Number [ CC ]

9.4.1.1.1. Type

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

9.4.1.1.2. Number *

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

9.4.1.1.Telephone Number

9.4.2. Email Addresses [ CC ]

9.4.2.1. Email Address [ CC ]

9.4.2.1.1. Email Address

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

9.4.2.1.Email Address

9.5. Coverage by social security scheme [ SC ]

9.5.1. Periods Covered by security scheme in sending Member State

[ SC ]

9.5.1.1. Period

[ CC ]

9.5.1.1.1. Start Date *

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

9.5.1.1.2. End Date *

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

9.5.1.1.Period

9.5.2. Periods Not covered [ SC ]

9.5.2.1. Period Not Covered

[ CC ]

9.5.2.1.1. Start Date *

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

9.5.2.1.2. End Date *

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

9.5.2.1.Period Not Covered

9.5.3. Periods of Entitlement [ SC ]

Entitlement to Family Benefits, if yes [ SC ]

If no entitlement, choose one reason [ SC ]

9.5.3.1.1. Period Entitlement Family Benefits [ SC ]

9.5.3.1.1.1. Period of Entitlement to family benefit

[ CC ]

9.5.3.1.1.1.1. Start Date *

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

9.5.3.1.1.1.2. End Date *

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

9.5.3.1.1.1.Period of Entitlement to family benefit

9.5.3.2.1. Reason

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

9.5.3.2.2. Other reason

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

9.6. Family relationship of the claimant to spouse or other person [ SC ]

9.6.1. Relationships [ SC ]

9.6.1.1. Family relationship

[ SC ]

9.6.1.1.1. Family Relationship

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

9.6.1.1.2. Other

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

9.6.1.1.3. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

9.6.1.1.3.1.1. Start date *

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

9.6.1.1.3.1.2. End date *

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

9.6.1.1.3.2.1. Type of Open Period *

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

9.6.1.1.3.2.2. Start date *

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

9.6.1.1.4. Other relationship

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

9.6.1.1.5. Name of person

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

9.6.1.1.6. Date of relationship

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

9.6.1.1.7. Was the claimant a member of the same household as the person in question

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

9.6.1.1.Family relationship

9.7. Status of the person [ SC ]

Person is regarded as an active person [ SC ]

Person is regarded as a non-active person [ SC ]

No information about activity of person [ SC ]

9.7.1.1. Type of Employment *

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

9.7.1.2. Periods of Employment *

[ SC ]

9.7.1.2.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

9.7.1.2.1.1.1. Start date *

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

9.7.1.2.1.1.2. End date *

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

9.7.1.2.1.2.1. Type of Open Period *

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

9.7.1.2.1.2.2. Start date *

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

9.7.1.2.1.Period

9.7.2.1. Type of non-Active Person *

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

9.7.2.2. Periods of Non Activity * [ SC ]

9.7.2.2.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

9.7.2.2.1.1.1. Start date *

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

9.7.2.2.1.1.2. End date *

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

9.7.2.2.1.2.1. Type of Open Period *

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

9.7.2.2.1.2.2. Start date *

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

9.7.2.2.1.Period

9.7.3.1. Periods of Non Activity * [ SC ]

9.7.3.1.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

9.7.3.1.1.1.1. Start date *

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

9.7.3.1.1.1.2. End date *

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

9.7.3.1.1.2.1. Type of Open Period *

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

9.7.3.1.1.2.2. Start date *

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

9.7.3.1.1.Period

9.7.3.2. Additional Information

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

9.7.4. Employment Periods

[ SC ]

9.7.4.1. Employment period

[ CC ]

9.7.4.1.1. Start Date *

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

9.7.4.1.2. End Date *

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

9.7.4.1.Employment period

9.7.5. Additional information

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

9.7.6. Periods of pension received in sending Member State

[ SC ]

9.7.6.1. Period of pension received in sending Member State [ SC ]

9.7.6.1.1. Type of pension

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

9.7.6.1.2. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

9.7.6.1.2.1.1. Start date *

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

9.7.6.1.2.1.2. End date *

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

9.7.6.1.2.2.1. Type of Open Period *

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

9.7.6.1.2.2.2. Start date *

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

9.7.6.1.Period of pension received in sending Member State

9.7.7. Insurance periods in sending Member State

[ SC ]

9.7.7.1. Insurance Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

9.7.7.1.1.1. Start date *

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

9.7.7.1.1.2. End date *

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

9.7.7.1.2.1. Type of Open Period *

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

9.7.7.1.2.2. Start date *

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

9.7.7.1.Insurance Period

9.7.8. Grounds for residence [ SC ]

9.7.8.1. Durations on territory

[ SC ]

9.7.8.1.1. Duration on territory [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

9.7.8.1.1.1.1. Start date *

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

9.7.8.1.1.1.2. End date *

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

9.7.8.1.1.2.1. Type of Open Period *

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

9.7.8.1.1.2.2. Start date *

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

9.7.8.1.1.Duration on territory

9.7.8.2. Moving date into sending Member State

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

9.7.8.3. Moving date into receiving Member State

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

9.7.8.4. Personal situation elements (article 11 of Regulation (EC) No 987/2009)

[ CDT ] {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$error}} {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$warning}}

10. Information on other person

[ SC ]

10.1. Person Identification * [ CC ]

10.1.1. Family name(s) *

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

10.1.2. Forename(s) *

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

10.1.3. Date of birth *

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

10.1.4. Sex *

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

10.1.5. Family name(s) at birth

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

10.1.6. Forename(s) at birth

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

10.1.7. PIN of the person in each institution

[ CC ]

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

10.1.7.1.1. Country *

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

10.1.7.1.2. Personal Identification Number (PIN) *

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

10.1.7.1.3. Sector

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

10.1.7.1.4. Institution

[ CC ]

10.1.7.1.4.1. Institution ID *

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

10.1.7.1.4.2. Institution Name *

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

10.1.7.1.Personal Identification Number(s)

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

[ CC ]

10.1.8.1. Place of birth

[ CC ]

10.1.8.1.1. Town *

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

10.1.8.1.2. Region

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

10.1.8.1.3. Country *

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

10.1.8.2. Father's family name at birth

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

10.1.8.3. Forename of father

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

10.1.8.4. Mother's family name at birth

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

10.1.8.5. Forename of mother

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

10.2. Additional information about nationality [ SC ]

10.2.1. Nationalities [ SC ]

10.2.1.1. Nationality *

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

10.2.1.2. Since

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

10.2.1.Nationalities

10.3. Addresses of the person

[ SC ]

10.3.1. Address of the Person

[ SC ]

10.3.1.1. Type of address

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

10.3.1.2. Address

[ CC ]

10.3.1.2.1. Street

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

10.3.1.2.2. Building Name

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

10.3.1.2.3. Town *

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

10.3.1.2.4. Postal Code

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

10.3.1.2.5. Region

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

10.3.1.2.6. Country *

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

10.3.1.Address of the Person

10.4. Contact Details [ CC ]

10.4.1. Telephone Numbers [ CC ]

10.4.1.1. Telephone Number [ CC ]

10.4.1.1.1. Type

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

10.4.1.1.2. Number *

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

10.4.1.1.Telephone Number

10.4.2. Email Addresses [ CC ]

10.4.2.1. Email Address [ CC ]

10.4.2.1.1. Email Address

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

10.4.2.1.Email Address

10.5. Coverage by social security scheme [ SC ]

10.5.1. Periods Covered by security scheme in sending Member State

[ SC ]

10.5.1.1. Period

[ CC ]

10.5.1.1.1. Start Date *

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

10.5.1.1.2. End Date *

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

10.5.1.1.Period

10.5.2. Periods Not covered [ SC ]

10.5.2.1. Period Not Covered

[ CC ]

10.5.2.1.1. Start Date *

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

10.5.2.1.2. End Date *

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

10.5.2.1.Period Not Covered

10.5.3. Periods of Entitlement [ SC ]

Entitlement to Family Benefits, if yes [ SC ]

If no entitlement, choose one reason [ SC ]

10.5.3.1.1. Period Entitlement Family Benefits [ SC ]

10.5.3.1.1.1. Period of Entitlement to family benefit

[ CC ]

10.5.3.1.1.1.1. Start Date *

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

10.5.3.1.1.1.2. End Date *

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

10.5.3.1.1.1.Period of Entitlement to family benefit

10.5.3.2.1. Reason

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

10.5.3.2.2. Other reason

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

10.6. Family relationship of the claimant to spouse or other person [ SC ]

10.6.1. Relationships [ SC ]

10.6.1.1. Family relationship

[ SC ]

10.6.1.1.1. Family Relationship

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

10.6.1.1.2. Other

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

10.6.1.1.3. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.6.1.1.3.1.1. Start date *

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

10.6.1.1.3.1.2. End date *

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

10.6.1.1.3.2.1. Type of Open Period *

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

10.6.1.1.3.2.2. Start date *

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

10.6.1.1.4. Other relationship

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

10.6.1.1.5. Name of person

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

10.6.1.1.6. Date of relationship

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

10.6.1.1.7. Was the claimant a member of the same household as the person in question

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

10.6.1.1.Family relationship

10.7. Status of the person [ SC ]

Person is regarded as an active person [ SC ]

Person is regarded as a non-active person [ SC ]

No information about activity of person [ SC ]

10.7.1.1. Type of Employment *

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

10.7.1.2. Periods of Employment *

[ SC ]

10.7.1.2.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.7.1.2.1.1.1. Start date *

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

10.7.1.2.1.1.2. End date *

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

10.7.1.2.1.2.1. Type of Open Period *

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

10.7.1.2.1.2.2. Start date *

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

10.7.1.2.1.Period

10.7.2.1. Type of non-Active Person *

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

10.7.2.2. Periods of Non Activity * [ SC ]

10.7.2.2.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.7.2.2.1.1.1. Start date *

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

10.7.2.2.1.1.2. End date *

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

10.7.2.2.1.2.1. Type of Open Period *

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

10.7.2.2.1.2.2. Start date *

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

10.7.2.2.1.Period

10.7.3.1. Periods of Non Activity * [ SC ]

10.7.3.1.1. Period * [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.7.3.1.1.1.1. Start date *

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

10.7.3.1.1.1.2. End date *

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

10.7.3.1.1.2.1. Type of Open Period *

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

10.7.3.1.1.2.2. Start date *

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

10.7.3.1.1.Period

10.7.3.2. Additional Information

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

10.7.4. Employment Periods

[ SC ]

10.7.4.1. Employment period

[ CC ]

10.7.4.1.1. Start Date *

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

10.7.4.1.2. End Date *

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

10.7.4.1.Employment period

10.7.5. Additional information

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

10.7.6. Periods of pension received in sending Member State

[ SC ]

10.7.6.1. Period of pension received in sending Member State [ SC ]

10.7.6.1.1. Type of pension

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

10.7.6.1.2. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.7.6.1.2.1.1. Start date *

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

10.7.6.1.2.1.2. End date *

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

10.7.6.1.2.2.1. Type of Open Period *

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

10.7.6.1.2.2.2. Start date *

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

10.7.6.1.Period of pension received in sending Member State

10.7.7. Insurance periods in sending Member State

[ SC ]

10.7.7.1. Insurance Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.7.7.1.1.1. Start date *

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

10.7.7.1.1.2. End date *

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

10.7.7.1.2.1. Type of Open Period *

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

10.7.7.1.2.2. Start date *

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

10.7.7.1.Insurance Period

10.7.8. Grounds for residence [ SC ]

10.7.8.1. Durations on territory

[ SC ]

10.7.8.1.1. Duration on territory [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

10.7.8.1.1.1.1. Start date *

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

10.7.8.1.1.1.2. End date *

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

10.7.8.1.1.2.1. Type of Open Period *

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

10.7.8.1.1.2.2. Start date *

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

10.7.8.1.1.Duration on territory

10.7.8.2. Moving date into sending Member State

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

10.7.8.3. Moving date into receiving Member State

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

10.7.8.4. Personal situation elements (article 11 of Regulation (EC) No 987/2009)

[ CDT ] {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$error}} {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$warning}}

11. Claiming authority

[ SC ]

11.1. Reason for authority claim

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

11.2. Claiming authority

[ CC ]

11.2.1. Institution ID *

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

11.2.2. Institution Name *

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

11.3. Bank details [ CC ]

SEPA account* [ CC ]

Non-SEPA account* [ CC ]

11.3.1.1. IBAN *

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

11.3.1.2. BIC-SWIFT

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

11.3.2.1. Account number *

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

11.3.2.2. BIC-SWIFT *

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

11.3.2.3. Bank Name *

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

11.3.2.4. Bank Address *

[ CC ]

11.3.2.4.1. Street

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

11.3.2.4.2. Building Name

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

11.3.2.4.3. Town *

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

11.3.2.4.4. Postal Code

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

11.3.2.4.5. Region

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

11.3.2.4.6. Country *

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

12. Information on child(ren)

[ SC ]

12.1. Child for whom this decision applies * [ SC ]

12.1.1. Child Details [ CC ]

12.1.1.1. Family name(s) *

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

12.1.1.2. Forename(s) *

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

12.1.1.3. Date of birth *

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

12.1.1.4. Sex *

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

12.1.1.5. Family name(s) at birth

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

12.1.1.6. Forename(s) at birth

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

12.1.1.7. PIN of the person in each institution

[ CC ]

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

12.1.1.7.1.1. Country *

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

12.1.1.7.1.2. Personal Identification Number (PIN) *

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

12.1.1.7.1.3. Sector

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

12.1.1.7.1.4. Institution

[ CC ]

12.1.1.7.1.4.1. Institution ID *

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

12.1.1.7.1.4.2. Institution Name *

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

12.1.1.7.1.Personal Identification Number(s)

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

[ CC ]

12.1.1.8.1. Place of birth

[ CC ]

12.1.1.8.1.1. Town *

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

12.1.1.8.1.2. Region

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

12.1.1.8.1.3. Country *

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

12.1.1.8.2. Father's family name at birth

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

12.1.1.8.3. Forename of father

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

12.1.1.8.4. Mother's family name at birth

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

12.1.1.8.5. Forename of mother

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

12.1.2. Additional information about nationality [ SC ]

12.1.2.1. Nationalities [ SC ]

12.1.2.1.1. Nationality *

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

12.1.2.1.2. Since

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

12.1.2.1.Nationalities

12.1.3. Addresses of the child [ SC ]

12.1.3.1. Address of the Person

[ SC ]

12.1.3.1.1. Type of address

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

12.1.3.1.2. Address

[ CC ]

12.1.3.1.2.1. Street

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

12.1.3.1.2.2. Building Name

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

12.1.3.1.2.3. Town *

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

12.1.3.1.2.4. Postal Code

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

12.1.3.1.2.5. Region

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

12.1.3.1.2.6. Country *

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

12.1.3.1.Address of the Person

12.1.4. Relationships to claimant, spouse/partner or other person [ SC ]

12.1.4.1. Relationship per child [ SC ]

12.1.4.1.1. Relationship with *

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

12.1.4.1.2. Type *

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

12.1.4.1.3. Period of Relationship [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

12.1.4.1.3.1.1. Start date *

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

12.1.4.1.3.1.2. End date *

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

12.1.4.1.3.2.1. Type of Open Period *

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

12.1.4.1.3.2.2. Start date *

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

12.1.4.1.4. Joint custody

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

12.1.4.1.5. Child(ren)'s household [ SC ]

12.1.4.1.5.1. Is the child a member of the same household as the claimant

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

12.1.4.1.5.2. Is the child a member of the same household as the spouse/partner in question

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

12.1.4.1.5.3. Is the child a member of the same household as the other person in question

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

12.1.4.1.5.4. Is child in the institution

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

12.1.4.1.Relationship per child

12.1.5. Grounds for residence [ SC ]

12.1.5.1. Durations on territory

[ SC ]

12.1.5.1.1. Duration on territory [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

12.1.5.1.1.1.1. Start date *

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

12.1.5.1.1.1.2. End date *

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

12.1.5.1.1.2.1. Type of Open Period *

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

12.1.5.1.1.2.2. Start date *

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

12.1.5.1.1.Duration on territory

12.1.5.2. Moving date into sending Member State

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

12.1.5.3. Moving date into receiving Member State

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

12.1.5.4. Personal situation elements (article 11 of Regulation (EC) No 987/2009)

[ CDT ] {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$error}} {{metaSection.personalSituationElementsArticle11RegulationECNo9872009.$$warning}}

12.1.Child for whom this decision applies

13. Amounts, names and currencies for family benefits of the Children

[ SC ]

13.1. Amount, name and currency for family benefits for a child

[ SC ]

13.1.1. Name of child

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

13.1.2. Name of benefit

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

13.1.3. Family Benefit Details [ SC ]

13.1.3.1. Amount [ CC ]

13.1.3.1.1. Amount *

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

13.1.3.1.2. Currency *

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

13.1.3.2. Date for granted benefits

[ CC ]

13.1.3.2.1. Start Date *

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

13.1.3.2.2. End Date *

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

13.1.3.3. Period definition *

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

13.1.3.4. Name of beneficiary

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

13.1.Amount, name and currency for family benefits for a child

14. Amounts of family benefit(s) for the entire family

[ SC ]

14.1. Amount of Family Benefit

[ SC ]

14.1.1. Name of benefit

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

14.1.2. Number of persons benefits are granted for

[ PRIM ] {{metaSection.numberPersonsBenefitsAreGrantedFor.$$error}} {{metaSection.numberPersonsBenefitsAreGrantedFor.$$warning}}

14.1.3. Family Benefit Details [ SC ]

14.1.3.1. Amount [ CC ]

14.1.3.1.1. Amount *

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

14.1.3.1.2. Currency *

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

14.1.3.2. Date for granted benefits

[ CC ]

14.1.3.2.1. Start Date *

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

14.1.3.2.2. End Date *

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

14.1.3.3. Period definition *

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

14.1.3.4. Name of beneficiary

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

14.1.Amount of Family Benefit

15. Request or reply to request for offsetting of family benefits for children

[ SED ]

15.1. Request or reply to request for offsetting of family benefits for a child [ SED ]

15.1.1. Request or reply to request for offsetting of family benefits for a child

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

15.1.2. Name of child

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

15.1.3. Name of benefit

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

15.1.4. Family Benefit Details [ SC ]

15.1.4.1. Amount [ CC ]

15.1.4.1.1. Amount *

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

15.1.4.1.2. Currency *

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

15.1.4.2. Date for granted benefits

[ CC ]

15.1.4.2.1. Start Date *

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

15.1.4.2.2. End Date *

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

15.1.4.3. Period definition *

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

15.1.4.4. Name of beneficiary

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

15.1.5. Grounds of request for overpayment offsetting

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

15.1.6. Additional information

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

15.1.7. Date of decision

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

15.1.Request or reply to request for offsetting of family benefits for a child

16. Request or reply to request for offsetting of family benefits for the entire family

[ SED ]

16.1. Request or reply to request for offsetting of family benefit for entire family [ SED ]

16.1.1. Request or reply to request for offsetting of family benefit for entire family

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

16.1.2. Name of benefit

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

16.1.3. Number of persons benefits are granted for

[ PRIM ] {{metaSection.numberPersonsBenefitsAreGrantedFor.$$error}} {{metaSection.numberPersonsBenefitsAreGrantedFor.$$warning}}

16.1.4. Family Benefit Details [ SC ]

16.1.4.1. Amount [ CC ]

16.1.4.1.1. Amount *

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

16.1.4.1.2. Currency *

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

16.1.4.2. Date for granted benefits

[ CC ]

16.1.4.2.1. Start Date *

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

16.1.4.2.2. End Date *

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

16.1.4.3. Period definition *

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

16.1.4.4. Name of beneficiary

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

16.1.5. Grounds of request for overpayment offsetting

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

16.1.6. Additional information

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

16.1.7. Date of decision

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

16.1.Request or reply to request for offsetting of family benefit for entire family

17. Claim for reimbursement with article 58 of Regulation (EC) No 987/2009 [ SC ]

17.1. Claim

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

{{ row.severityMessage }} : {{ row.message }}

F002 - Reply for determining competence Articles 1 (i), 11, 67, 68 of Regulation (EC) No 883/2004; Articles 2(2), 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(4), 60(5), 72, 73, 74 of Regulation (EC) No 987/2009

F002 - Reply for determining competence
Articles 1 (i), 11, 67, 68 of Regulation (EC) No 883/2004; Articles 2(2), 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(4), 60(5), 72, 73, 74 of Regulation (EC) No 987/2009