Reply to request to discharge of benefits

F017 - Reply to request to discharge of benefits
Article 68a of Regulation (EC) No 883/2004

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Reply to request

[ SED ]

1.1. Request accepted from

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

1.2. Payment of benefits starts

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

1.3. Request not accepted from

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

1.4. Legal grounds

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

1.5. Additional information

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

2. Former beneficiary *

[ SC ]

2.1. Person Identification * [ CC ]

2.1.1. Family name(s) *

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

2.1.2. Forename(s) *

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

2.1.3. Date of birth *

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

2.1.4. Sex *

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

2.1.5. Family name(s) at birth

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

2.1.6. Forename(s) at birth

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

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 *

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

2.1.7.1.2. Personal Identification Number (PIN) *

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

2.1.7.1.3. Sector

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

2.1.7.1.4. Institution

[ CC ]

2.1.7.1.4.1. Institution ID *

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

2.1.7.1.4.2. Institution Name *

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

2.1.7.1.Personal Identification Number(s)

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 *

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

2.1.8.1.2. Region

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

2.1.8.1.3. Country *

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

2.1.8.2. Father's family name at birth

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

2.1.8.3. Forename of father

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

2.1.8.4. Mother's family name at birth

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

2.1.8.5. Forename of mother

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

2.2. Additional information about nationality [ SC ]

2.2.1. Nationalities [ SC ]

2.2.1.1. Nationality *

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

2.2.1.2. Since

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

2.2.1.Nationalities

2.3. Addresses of the person [ SC ]

2.3.1. Address of the Person

[ SC ]

2.3.1.1. Type of address

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

2.3.1.2. Address

[ CC ]

2.3.1.2.1. Street

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

2.3.1.2.2. Building Name

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

2.3.1.2.3. Town *

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

2.3.1.2.4. Postal Code

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

2.3.1.2.5. Region

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

2.3.1.2.6. Country *

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

2.3.1.Address of the Person

2.4. Contact Details [ CC ]

2.4.1. Telephone Numbers [ CC ]

2.4.1.1. Telephone Number [ CC ]

2.4.1.1.1. Type

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

2.4.1.1.2. Number *

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

2.4.1.1.Telephone Number

2.4.2. Email Addresses [ CC ]

2.4.2.1. Email Address [ CC ]

2.4.2.1.1. Email Address

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

2.4.2.1.Email Address

2.5. Coverage by social security scheme [ SC ]

2.5.1. Periods Covered by security scheme in sending Member State

[ SC ]

2.5.1.1. Period

[ CC ]

2.5.1.1.1. Start Date *

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

2.5.1.1.2. End Date *

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

2.5.1.1.Period

2.5.2. Periods Not covered [ SC ]

2.5.2.1. Period Not Covered

[ CC ]

2.5.2.1.1. Start Date *

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

2.5.2.1.2. End Date *

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

2.5.2.1.Period Not Covered

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 *

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

2.5.3.1.1.1.2. End Date *

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

2.5.3.1.1.1.Period of Entitlement to family benefit

2.5.3.2.1. Reason

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

2.5.3.2.2. Other reason

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

3. Approved Beneficiary

[ SED ]

3.1. Approved Beneficiary

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

4. Information on spouse or partner

[ SC ]

4.1. Person Identification * [ CC ]

4.1.1. Family name(s) *

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

4.1.2. Forename(s) *

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

4.1.3. Date of birth *

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

4.1.4. Sex *

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

4.1.5. Family name(s) at birth

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

4.1.6. Forename(s) at birth

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

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 *

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

4.1.7.1.2. Personal Identification Number (PIN) *

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

4.1.7.1.3. Sector

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

4.1.7.1.4. Institution

[ CC ]

4.1.7.1.4.1. Institution ID *

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

4.1.7.1.4.2. Institution Name *

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

4.1.7.1.Personal Identification Number(s)

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

4.1.8.1.2. Region

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

4.1.8.1.3. Country *

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

4.1.8.2. Father's family name at birth

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

4.1.8.3. Forename of father

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

4.1.8.4. Mother's family name at birth

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

4.1.8.5. Forename of mother

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

4.2. Additional information about nationality [ SC ]

4.2.1. Nationalities [ SC ]

4.2.1.1. Nationality *

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

4.2.1.2. Since

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

4.2.1.Nationalities

4.3. Addresses of the person [ SC ]

4.3.1. Address of the Person

[ SC ]

4.3.1.1. Type of address

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

4.3.1.2. Address

[ CC ]

4.3.1.2.1. Street

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

4.3.1.2.2. Building Name

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

4.3.1.2.3. Town *

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

4.3.1.2.4. Postal Code

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

4.3.1.2.5. Region

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

4.3.1.2.6. Country *

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

4.3.1.Address of the Person

4.4. Contact Details [ CC ]

4.4.1. Telephone Numbers [ CC ]

4.4.1.1. Telephone Number [ CC ]

4.4.1.1.1. Type

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

4.4.1.1.2. Number *

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

4.4.1.1.Telephone Number

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}}

4.4.2.1.Email Address

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

4.5.1.1.2. End Date *

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

4.5.1.1.Period

4.5.2. Periods Not covered [ SC ]

4.5.2.1. Period Not Covered

[ CC ]

4.5.2.1.1. Start Date *

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

4.5.2.1.2. End Date *

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

4.5.2.1.Period Not Covered

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

4.5.3.1.1.1.2. End Date *

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

4.5.3.1.1.1.Period of Entitlement to family benefit

4.5.3.2.1. Reason

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

4.5.3.2.2. Other reason

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

5. Information on other person

[ SC ]

5.1. Person Identification * [ CC ]

5.1.1. Family name(s) *

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

5.1.2. Forename(s) *

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

5.1.3. Date of birth *

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

5.1.4. Sex *

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

5.1.5. Family name(s) at birth

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

5.1.6. Forename(s) at birth

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

5.1.7. PIN of the person in each institution

[ CC ]

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

5.1.7.1.1. Country *

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

5.1.7.1.2. Personal Identification Number (PIN) *

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

5.1.7.1.3. Sector

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

5.1.7.1.4. Institution

[ CC ]

5.1.7.1.4.1. Institution ID *

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

5.1.7.1.4.2. Institution Name *

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

5.1.7.1.Personal Identification Number(s)

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

[ CC ]

5.1.8.1. Place of birth

[ CC ]

5.1.8.1.1. Town *

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

5.1.8.1.2. Region

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

5.1.8.1.3. Country *

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

5.1.8.2. Father's family name at birth

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

5.1.8.3. Forename of father

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

5.1.8.4. Mother's family name at birth

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

5.1.8.5. Forename of mother

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

5.2. Additional information about nationality [ SC ]

5.2.1. Nationalities [ SC ]

5.2.1.1. Nationality *

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

5.2.1.2. Since

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

5.2.1.Nationalities

5.3. Addresses of the person [ SC ]

5.3.1. Address of the Person

[ SC ]

5.3.1.1. Type of address

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

5.3.1.2. Address

[ CC ]

5.3.1.2.1. Street

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

5.3.1.2.2. Building Name

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

5.3.1.2.3. Town *

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

5.3.1.2.4. Postal Code

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

5.3.1.2.5. Region

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

5.3.1.2.6. Country *

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

5.3.1.Address of the Person

5.4. Contact Details [ CC ]

5.4.1. Telephone Numbers [ CC ]

5.4.1.1. Telephone Number [ CC ]

5.4.1.1.1. Type

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

5.4.1.1.2. Number *

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

5.4.1.1.Telephone Number

5.4.2. Email Addresses [ CC ]

5.4.2.1. Email Address [ CC ]

5.4.2.1.1. Email Address

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

5.4.2.1.Email Address

5.5. Coverage by social security scheme [ SC ]

5.5.1. Periods Covered by security scheme in sending Member State

[ SC ]

5.5.1.1. Period

[ CC ]

5.5.1.1.1. Start Date *

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

5.5.1.1.2. End Date *

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

5.5.1.1.Period

5.5.2. Periods Not covered [ SC ]

5.5.2.1. Period Not Covered

[ CC ]

5.5.2.1.1. Start Date *

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

5.5.2.1.2. End Date *

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

5.5.2.1.Period Not Covered

5.5.3. Periods of Entitlement [ SC ]

Entitlement to Family Benefits, if yes [ SC ]

If no entitlement, choose one reason [ SC ]

5.5.3.1.1. Period Entitlement Family Benefits [ SC ]

5.5.3.1.1.1. Period of Entitlement to family benefit

[ CC ]

5.5.3.1.1.1.1. Start Date *

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

5.5.3.1.1.1.2. End Date *

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

5.5.3.1.1.1.Period of Entitlement to family benefit

5.5.3.2.1. Reason

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

5.5.3.2.2. Other reason

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

6. Claiming authority

[ SC ]

6.1. Reason for authority claim

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

6.2. Claiming authority

[ CC ]

6.2.1. Institution ID *

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

6.2.2. Institution Name *

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

6.3. Bank details [ CC ]

SEPA account* [ CC ]

Non-SEPA account* [ CC ]

6.3.1.1. IBAN *

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

6.3.1.2. BIC-SWIFT

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

6.3.2.1. Account number *

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

6.3.2.2. BIC-SWIFT *

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

6.3.2.3. Bank Name *

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

6.3.2.4. Bank Address *

[ CC ]

6.3.2.4.1. Street

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

6.3.2.4.2. Building Name

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

6.3.2.4.3. Town *

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

6.3.2.4.4. Postal Code

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

6.3.2.4.5. Region

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

6.3.2.4.6. Country *

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

7. Information on child(ren)

[ SC ]

7.1. Child * [ SC ]

7.1.1. Child Details * [ CC ]

7.1.1.1. Family name(s) *

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

7.1.1.2. Forename(s) *

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

7.1.1.3. Date of birth *

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

7.1.1.4. Sex *

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

7.1.1.5. Family name(s) at birth

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

7.1.1.6. Forename(s) at birth

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

7.1.1.7. PIN of the person in each institution

[ CC ]

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

7.1.1.7.1.1. Country *

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

7.1.1.7.1.2. Personal Identification Number (PIN) *

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

7.1.1.7.1.3. Sector

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

7.1.1.7.1.4. Institution

[ CC ]

7.1.1.7.1.4.1. Institution ID *

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

7.1.1.7.1.4.2. Institution Name *

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

7.1.1.7.1.Personal Identification Number(s)

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

[ CC ]

7.1.1.8.1. Place of birth

[ CC ]

7.1.1.8.1.1. Town *

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

7.1.1.8.1.2. Region

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

7.1.1.8.1.3. Country *

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

7.1.1.8.2. Father's family name at birth

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

7.1.1.8.3. Forename of father

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

7.1.1.8.4. Mother's family name at birth

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

7.1.1.8.5. Forename of mother

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

7.1.2. Additional information about nationality [ SC ]

7.1.2.1. Nationalities [ SC ]

7.1.2.1.1. Nationality *

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

7.1.2.1.2. Since

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

7.1.2.1.Nationalities

7.1.3. Addresses of the child [ SC ]

7.1.3.1. Address of the Person

[ SC ]

7.1.3.1.1. Type of address

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

7.1.3.1.2. Address

[ CC ]

7.1.3.1.2.1. Street

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

7.1.3.1.2.2. Building Name

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

7.1.3.1.2.3. Town *

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

7.1.3.1.2.4. Postal Code

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

7.1.3.1.2.5. Region

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

7.1.3.1.2.6. Country *

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

7.1.3.1.Address of the Person

7.1.Child

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F017 - Reply to request to discharge of benefits Article 68a of Regulation (EC) No 883/2004

F017 - Reply to request to discharge of benefits
Article 68a of Regulation (EC) No 883/2004