Information on priority for additional benefits

1. Deceased person * [ SC ]

1.1. Person Identification * [ CC ]

1.1.1. Family name(s) *

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1.1.2. Forename(s) *

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1.1.3. Date of birth *

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1.1.4. Sex *

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1.1.5. Family name(s) at birth

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1.1.6. Forename(s) at birth

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1.1.7. PIN of the person in each institution [ CC ]

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

1.1.7.1.1. Country *

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1.1.7.1.2. Personal Identification Number (PIN) *

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1.1.7.1.3. Sector

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1.1.7.1.4. Institution [ CC ]

1.1.7.1.4.1. Institution ID *

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1.1.7.1.4.2. Institution Name *

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1.1.7.1.Personal Identification Number(s)

1.1.8. If PIN not provided for every institution, please provide [ CC ]

1.1.8.1. Place of birth [ CC ]

1.1.8.1.1. Town *

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1.1.8.1.2. Region

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1.1.8.1.3. Country *

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1.1.8.2. Father's family name at birth

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1.1.8.3. Forename of father

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1.1.8.4. Mother's family name at birth

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1.1.8.5. Forename of mother

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1.2. Additional information about nationality [ SC ]

1.2.1. Nationalities [ SC ]

1.2.1.1. Nationality *

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1.2.1.2. Since

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1.2.1.Nationalities

1.3. Details of Death [ SC ]

1.3.1. Place of Death

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1.3.2. Date of Death

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1.4. Person's latest addresses [ SC ]

1.4.1. Address of the Person [ SC ]

1.4.1.1. Type of address

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1.4.1.2. Address [ CC ]

1.4.1.2.1. Street

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1.4.1.2.2. Building Name

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1.4.1.2.3. Town *

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1.4.1.2.4. Postal Code

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1.4.1.2.5. Region

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1.4.1.2.6. Country *

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1.4.1.Address of the Person

1.5. Coverage by social security scheme [ SC ]

1.5.1. Periods Covered by security scheme in sending Member State [ SC ]

1.5.1.1. Period [ CC ]

1.5.1.1.1. Start Date *

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1.5.1.1.2. End Date *

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1.5.1.1.Period

1.5.2. Periods Not covered [ SC ]

1.5.2.1. Period Not Covered [ CC ]

1.5.2.1.1. Start Date *

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1.5.2.1.2. End Date *

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1.5.2.1.Period Not Covered

1.5.3. Periods of Entitlement [ SC ]

Entitlement to Family Benefits, if yes [ SC ]

If no entitlement, choose one reason [ SC ]

1.5.3.1.1. Period Entitlement Family Benefits [ SC ]

1.5.3.1.1.1. Period of Entitlement to family benefit [ CC ]

1.5.3.1.1.1.1. Start Date *

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1.5.3.1.1.1.2. End Date *

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1.5.3.1.1.1.Period of Entitlement to family benefit

1.5.3.2.1. Reason

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1.5.3.2.2. Other reason

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F020 - Information on priority for additional benefits Article 69 of Regulation (EC) No 883/2004; Article 61 of Regulation (EC) No 987/2009

F020 - Information on priority for additional benefits
Article 69 of Regulation (EC) No 883/2004; Article 61 of Regulation (EC) No 987/2009