F004 - Request for clarifications
Articles 67, 68 of Regulation (EC) No 883/2004, Articles 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(4) of Regulation (EC) No 987/2009
SED API version: 0.15.2 build 3
Model version: 4.1.0
1. Clarify the grounds for your decision
[ SC ]
1.1. Type of decision
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1.2. Date of your decision
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1.3. Grounds of Disagreement
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1.3.1. Employment/self-employment period/status
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1.3.2. Period of pension received
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1.3.3. Insurance period
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1.3.4. Duration on territory
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1.3.5. Residence of child(ren)
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1.3.6. Personal situation elements (article 11 of Regulation (EC) No 987/2009)
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1.3.7. Additional grounds for disagreement
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2. Claimant
*
[ SC ]
2.1. Person Identification
*
[ CC ]
2.1.1. Family name(s)
*
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2.1.2. Forename(s)
*
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2.1.3. Date of birth
*
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2.1.4. Sex
*
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2.1.5. Family name(s) at birth
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2.1.6. Forename(s) at birth
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2.1.7. PIN of the person in each institution
[ CC ]
2.1.7.1. Personal Identification Number(s)
*
[ CC ]
2.1.7.1.1. Country
*
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[ ENUM ]
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2.1.7.1.2. Personal Identification Number (PIN)
*
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2.1.7.1.3. Sector
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[ ENUM ]
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2.1.7.1.4. Institution
[ CC ]
2.1.7.1.4.1. Institution ID
*
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2.1.7.1.4.2. Institution Name
*
[ CDT ]
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2.1.8. If PIN not provided for every institution, please provide
[ CC ]
2.1.8.1. Place of birth
[ CC ]
2.1.8.1.1. Town
*
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2.1.8.1.2. Region
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2.1.8.1.3. Country
*
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[ ENUM ]
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2.1.8.2. Father's family name at birth
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2.1.8.3. Forename of father
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2.1.8.4. Mother's family name at birth
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2.1.8.5. Forename of mother
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2.2. Additional information about nationality
[ SC ]
2.2.1. Nationalities
[ SC ]
2.2.1.1. Nationality
*
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[ ENUM ]
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2.2.1.2. Since
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2.3. Addresses of the person
[ SC ]
2.3.1. Address of the Person
[ SC ]
2.3.1.1. Type of address
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[ ENUM ]
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2.3.1.2. Address
[ CC ]
2.3.1.2.1. Street
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2.3.1.2.2. Building Name
[ CDT ]
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2.3.1.2.3. Town
*
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2.3.1.2.4. Postal Code
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2.3.1.2.5. Region
[ CDT ]
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2.3.1.2.6. Country
*
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[ ENUM ]
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2.4. Contact Details
[ CC ]
2.4.1. Telephone Numbers
[ CC ]
2.4.1.1. Telephone Number
[ CC ]
2.4.1.1.1. Type
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[ ENUM ]
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2.4.1.1.2. Number
*
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2.4.2. Email Addresses
[ CC ]
2.4.2.1. Email Address
[ CC ]
2.4.2.1.1. Email Address
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2.5. Coverage by social security scheme
[ SC ]
2.5.1. Periods Covered by security scheme in sending Member State
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2.5.1.1. Period
[ CC ]
2.5.1.1.1. Start Date
*
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2.5.1.1.2. End Date
*
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2.5.2. Periods Not covered
[ SC ]
2.5.2.1. Period Not Covered
[ CC ]
2.5.2.1.1. Start Date
*
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2.5.2.1.2. End Date
*
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2.5.3. Periods of Entitlement
[ SC ]
Entitlement to Family Benefits, if yes
[ SC ]
If no entitlement, choose one reason
[ SC ]
2.5.3.1.1. Period Entitlement Family Benefits
[ SC ]
2.5.3.1.1.1. Period of Entitlement to family benefit
[ CC ]
2.5.3.1.1.1.1. Start Date
*
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2.5.3.1.1.1.2. End Date
*
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2.5.3.2.1. Reason
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[ ENUM ]
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2.5.3.2.2. Other reason
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3. Information on spouse or partner
[ SC ]
3.1. Person Identification
*
[ CC ]
3.1.1. Family name(s)
*
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3.1.2. Forename(s)
*
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3.1.3. Date of birth
*
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3.1.4. Sex
*
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[ ENUM ]
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3.1.5. Family name(s) at birth
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3.1.6. Forename(s) at birth
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3.1.7. PIN of the person in each institution
[ CC ]
3.1.7.1. Personal Identification Number(s)
*
[ CC ]
3.1.7.1.1. Country
*
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[ ENUM ]
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3.1.7.1.2. Personal Identification Number (PIN)
*
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3.1.7.1.3. Sector
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[ ENUM ]
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3.1.7.1.4. Institution
[ CC ]
3.1.7.1.4.1. Institution ID
*
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3.1.7.1.4.2. Institution Name
*
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3.1.8. If PIN not provided for every institution, please provide
[ CC ]
3.1.8.1. Place of birth
[ CC ]
3.1.8.1.1. Town
*
[ CDT ]
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3.1.8.1.2. Region
[ CDT ]
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3.1.8.1.3. Country
*
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[ ENUM ]
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3.1.8.2. Father's family name at birth
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3.1.8.3. Forename of father
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3.1.8.4. Mother's family name at birth
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3.1.8.5. Forename of mother
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3.2. Additional information about nationality
[ SC ]
3.2.1. Nationalities
[ SC ]
3.2.1.1. Nationality
*
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[ ENUM ]
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3.2.1.2. Since
[ BDT ]
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3.3. Addresses of the person
[ SC ]
3.3.1. Address of the Person
[ SC ]
3.3.1.1. Type of address
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[ ENUM ]
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3.3.1.2. Address
[ CC ]
3.3.1.2.1. Street
[ CDT ]
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3.3.1.2.2. Building Name
[ CDT ]
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3.3.1.2.3. Town
*
[ CDT ]
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3.3.1.2.4. Postal Code
[ CDT ]
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3.3.1.2.5. Region
[ CDT ]
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3.3.1.2.6. Country
*
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[ ENUM ]
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3.4. Contact Details
[ CC ]
3.4.1. Telephone Numbers
[ CC ]
3.4.1.1. Telephone Number
[ CC ]
3.4.1.1.1. Type
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[ ENUM ]
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3.4.1.1.2. Number
*
[ BDT ]
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3.4.2. Email Addresses
[ CC ]
3.4.2.1. Email Address
[ CC ]
3.4.2.1.1. Email Address
[ BDT ]
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3.5. Coverage by social security scheme
[ SC ]
3.5.1. Periods Covered by security scheme in sending Member State
[ SC ]
3.5.1.1. Period
[ CC ]
3.5.1.1.1. Start Date
*
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3.5.1.1.2. End Date
*
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3.5.2. Periods Not covered
[ SC ]
3.5.2.1. Period Not Covered
[ CC ]
3.5.2.1.1. Start Date
*
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3.5.2.1.2. End Date
*
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3.5.3. Periods of Entitlement
[ SC ]
Entitlement to Family Benefits, if yes
[ SC ]
If no entitlement, choose one reason
[ SC ]
3.5.3.1.1. Period Entitlement Family Benefits
[ SC ]
3.5.3.1.1.1. Period of Entitlement to family benefit
[ CC ]
3.5.3.1.1.1.1. Start Date
*
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3.5.3.1.1.1.2. End Date
*
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3.5.3.2.1. Reason
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[ ENUM ]
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3.5.3.2.2. Other reason
[ CDT ]
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4. Information on other person
[ SC ]
4.1. Person Identification
*
[ CC ]
4.1.1. Family name(s)
*
[ BDT ]
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4.1.2. Forename(s)
*
[ BDT ]
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4.1.3. Date of birth
*
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4.1.4. Sex
*
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[ ENUM ]
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4.1.5. Family name(s) at birth
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4.1.6. Forename(s) at birth
[ BDT ]
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4.1.7. PIN of the person in each institution
[ CC ]
4.1.7.1. Personal Identification Number(s)
*
[ CC ]
4.1.7.1.1. Country
*
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[ ENUM ]
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4.1.7.1.2. Personal Identification Number (PIN)
*
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4.1.7.1.3. Sector
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[ ENUM ]
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4.1.7.1.4. Institution
[ CC ]
4.1.7.1.4.1. Institution ID
*
[ BDT ]
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4.1.7.1.4.2. Institution Name
*
[ CDT ]
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4.1.8. If PIN not provided for every institution, please provide
[ CC ]
4.1.8.1. Place of birth
[ CC ]
4.1.8.1.1. Town
*
[ CDT ]
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4.1.8.1.2. Region
[ CDT ]
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4.1.8.1.3. Country
*
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[ ENUM ]
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4.1.8.2. Father's family name at birth
[ BDT ]
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4.1.8.3. Forename of father
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4.1.8.4. Mother's family name at birth
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4.1.8.5. Forename of mother
[ BDT ]
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4.2. Additional information about nationality
[ SC ]
4.2.1. Nationalities
[ SC ]
4.2.1.1. Nationality
*
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[ ENUM ]
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4.2.1.2. Since
[ BDT ]
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4.3. Addresses of the person
[ SC ]
4.3.1. Address of the Person
[ SC ]
4.3.1.1. Type of address
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[ ENUM ]
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4.3.1.2. Address
[ CC ]
4.3.1.2.1. Street
[ CDT ]
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4.3.1.2.2. Building Name
[ CDT ]
{{metaSection.buildingName.$$error}}
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4.3.1.2.3. Town
*
[ CDT ]
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4.3.1.2.4. Postal Code
[ CDT ]
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4.3.1.2.5. Region
[ CDT ]
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4.3.1.2.6. Country
*
{{$select.selected[ 'name']}}
[ ENUM ]
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4.4. Contact Details
[ CC ]
4.4.1. Telephone Numbers
[ CC ]
4.4.1.1. Telephone Number
[ CC ]
4.4.1.1.1. Type
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[ ENUM ]
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4.4.1.1.2. Number
*
[ BDT ]
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4.4.2. Email Addresses
[ CC ]
4.4.2.1. Email Address
[ CC ]
4.4.2.1.1. Email Address
[ BDT ]
{{metaSection.email.$$error}}
{{metaSection.email.$$warning}}
4.5. Coverage by social security scheme
[ SC ]
4.5.1. Periods Covered by security scheme in sending Member State
[ SC ]
4.5.1.1. Period
[ CC ]
4.5.1.1.1. Start Date
*
[ BDT ]
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4.5.1.1.2. End Date
*
[ BDT ]
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4.5.2. Periods Not covered
[ SC ]
4.5.2.1. Period Not Covered
[ CC ]
4.5.2.1.1. Start Date
*
[ BDT ]
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4.5.2.1.2. End Date
*
[ BDT ]
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{{metaSection.endDate.$$warning}}
4.5.3. Periods of Entitlement
[ SC ]
Entitlement to Family Benefits, if yes
[ SC ]
If no entitlement, choose one reason
[ SC ]
4.5.3.1.1. Period Entitlement Family Benefits
[ SC ]
4.5.3.1.1.1. Period of Entitlement to family benefit
[ CC ]
4.5.3.1.1.1.1. Start Date
*
[ BDT ]
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4.5.3.1.1.1.2. End Date
*
[ BDT ]
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4.5.3.2.1. Reason
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[ ENUM ]
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4.5.3.2.2. Other reason
[ CDT ]
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5. Claiming authority
[ SC ]
5.1. Reason for authority claim
[ CDT ]
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5.2. Claiming authority
[ CC ]
5.2.1. Institution ID
*
[ BDT ]
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5.2.2. Institution Name
*
[ CDT ]
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5.3. Bank details
[ CC ]
SEPA account
*
[ CC ]
Non-SEPA account
*
[ CC ]
5.3.1.1. IBAN
*
[ BDT ]
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5.3.1.2. BIC-SWIFT
[ BDT ]
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5.3.2.1. Account number
*
[ CDT ]
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5.3.2.2. BIC-SWIFT
*
[ BDT ]
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5.3.2.3. Bank Name
*
[ CDT ]
{{metaSection.bankName.$$error}}
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5.3.2.4. Bank Address
*
[ CC ]
5.3.2.4.1. Street
[ CDT ]
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5.3.2.4.2. Building Name
[ CDT ]
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
5.3.2.4.3. Town
*
[ CDT ]
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5.3.2.4.4. Postal Code
[ CDT ]
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{{metaSection.postalCode.$$warning}}
5.3.2.4.5. Region
[ CDT ]
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5.3.2.4.6. Country
*
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[ ENUM ]
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6. Information on child(ren)
*
[ SC ]
6.1. Child
*
[ SC ]
6.1.1. Child Details
*
[ CC ]
6.1.1.1. Family name(s)
*
[ BDT ]
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
6.1.1.2. Forename(s)
*
[ BDT ]
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
6.1.1.3. Date of birth
*
[ BDT ]
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6.1.1.4. Sex
*
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[ ENUM ]
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6.1.1.5. Family name(s) at birth
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6.1.1.6. Forename(s) at birth
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6.1.1.7. PIN of the person in each institution
[ CC ]
6.1.1.7.1. Personal Identification Number(s)
*
[ CC ]
6.1.1.7.1.1. Country
*
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[ ENUM ]
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6.1.1.7.1.2. Personal Identification Number (PIN)
*
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6.1.1.7.1.3. Sector
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6.1.1.7.1.4. Institution
[ CC ]
6.1.1.7.1.4.1. Institution ID
*
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6.1.1.7.1.4.2. Institution Name
*
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6.1.1.8. If PIN not provided for every institution, please provide
[ CC ]
6.1.1.8.1. Place of birth
[ CC ]
6.1.1.8.1.1. Town
*
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6.1.1.8.1.2. Region
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6.1.1.8.1.3. Country
*
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6.1.1.8.2. Father's family name at birth
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6.1.1.8.3. Forename of father
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6.1.1.8.4. Mother's family name at birth
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6.1.1.8.5. Forename of mother
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6.1.2. Additional information about nationality
[ SC ]
6.1.2.1. Nationalities
[ SC ]
6.1.2.1.1. Nationality
*
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6.1.2.1.2. Since
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6.1.3. Addresses of the child
[ SC ]
6.1.3.1. Address of the Person
[ SC ]
6.1.3.1.1. Type of address
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[ ENUM ]
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6.1.3.1.2. Address
[ CC ]
6.1.3.1.2.1. Street
[ CDT ]
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6.1.3.1.2.2. Building Name
[ CDT ]
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6.1.3.1.2.3. Town
*
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6.1.3.1.2.4. Postal Code
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6.1.3.1.2.5. Region
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6.1.3.1.2.6. Country
*
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[ ENUM ]
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