Application for additional benefits

F021 - Application for additional benefits
Articles 69, 81 of Regulation (EC) No 883/2004; Article 61 of Regulation (EC) No 987/2009

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Receipt of application for additional or special family benefit for orphans [ SED ]

1.1. Date of receipt of the application

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

1.2. Type of claim

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

1.3. Information on application

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

1.4. Points for which more information is needed

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

2. Deceased person *

[ 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. Details of Death [ SC ]

2.3.1. Place of Death

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

2.3.2. Date of Death

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

2.4. Person's latest addresses

[ SC ]

2.4.1. Address of the Person

[ SC ]

2.4.1.1. Type of address

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

2.4.1.2. Address

[ CC ]

2.4.1.2.1. Street

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

2.4.1.2.2. Building Name

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

2.4.1.2.3. Town *

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

2.4.1.2.4. Postal Code

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

2.4.1.2.5. Region

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

2.4.1.2.6. Country *

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

2.4.1.Address of the Person

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. Additional information

[ SC ]

3.1. Additional information

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

4. Information on spouse or partner

[ SED ]

4.1. Is the person the claimant?

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

4.2. Person Identification * [ CC ]

4.2.1. Family name(s) *

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

4.2.2. Forename(s) *

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

4.2.3. Date of birth *

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

4.2.4. Sex *

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

4.2.5. Family name(s) at birth

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

4.2.6. Forename(s) at birth

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

4.2.7. PIN of the person in each institution

[ CC ]

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

4.2.7.1.1. Country *

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

4.2.7.1.2. Personal Identification Number (PIN) *

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

4.2.7.1.3. Sector

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

4.2.7.1.4. Institution

[ CC ]

4.2.7.1.4.1. Institution ID *

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

4.2.7.1.4.2. Institution Name *

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

4.2.7.1.Personal Identification Number(s)

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

[ CC ]

4.2.8.1. Place of birth

[ CC ]

4.2.8.1.1. Town *

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

4.2.8.1.2. Region

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

4.2.8.1.3. Country *

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

4.2.8.2. Father's family name at birth

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

4.2.8.3. Forename of father

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

4.2.8.4. Mother's family name at birth

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

4.2.8.5. Forename of mother

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

4.3. Additional information about nationality [ SC ]

4.3.1. Nationalities [ SC ]

4.3.1.1. Nationality *

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

4.3.1.2. Since

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

4.3.1.Nationalities

4.4. Addresses of the person

[ SC ]

4.4.1. Address of the Person

[ SC ]

4.4.1.1. Type of address

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

4.4.1.2. Address

[ CC ]

4.4.1.2.1. Street

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

4.4.1.2.2. Building Name

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

4.4.1.2.3. Town *

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

4.4.1.2.4. Postal Code

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

4.4.1.2.5. Region

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

4.4.1.2.6. Country *

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

4.4.1.Address of the Person

4.5. Contact Details [ CC ]

4.5.1. Telephone Numbers [ CC ]

4.5.1.1. Telephone Number [ CC ]

4.5.1.1.1. Type

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

4.5.1.1.2. Number *

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

4.5.1.1.Telephone Number

4.5.2. Email Addresses [ CC ]

4.5.2.1. Email Address [ CC ]

4.5.2.1.1. Email Address

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

4.5.2.1.Email Address

4.6. Coverage by social security scheme [ SC ]

4.6.1. Periods Covered by security scheme in sending Member State

[ SC ]

4.6.1.1. Period

[ CC ]

4.6.1.1.1. Start Date *

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

4.6.1.1.2. End Date *

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

4.6.1.1.Period

4.6.2. Periods Not covered [ SC ]

4.6.2.1. Period Not Covered

[ CC ]

4.6.2.1.1. Start Date *

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

4.6.2.1.2. End Date *

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

4.6.2.1.Period Not Covered

4.6.3. Periods of Entitlement [ SC ]

Entitlement to Family Benefits, if yes [ SC ]

If no entitlement, choose one reason [ SC ]

4.6.3.1.1. Period Entitlement Family Benefits [ SC ]

4.6.3.1.1.1. Period of Entitlement to family benefit

[ CC ]

4.6.3.1.1.1.1. Start Date *

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

4.6.3.1.1.1.2. End Date *

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

4.6.3.1.1.1.Period of Entitlement to family benefit

4.6.3.2.1. Reason

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

4.6.3.2.2. Other reason

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

4.7. Family relationship of deceased person to the spouse, partner or other person [ SC ]

4.7.1. Relationships [ SC ]

4.7.1.1. Family relationship

[ SC ]

4.7.1.1.1. Family Relationship

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

4.7.1.1.2. Other

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

4.7.1.1.3. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

4.7.1.1.3.1.1. Start date *

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

4.7.1.1.3.1.2. End date *

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

4.7.1.1.3.2.1. Type of Open Period *

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

4.7.1.1.3.2.2. Start date *

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

4.7.1.1.4. Other relationship

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

4.7.1.1.5. Name of person

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

4.7.1.1.6. Date of relationship

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

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

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

4.7.1.1.Family relationship

5. Information on other person

[ SED ]

5.1. Is the person the claimant?

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

5.2. Person Identification * [ CC ]

5.2.1. Family name(s) *

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

5.2.2. Forename(s) *

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

5.2.3. Date of birth *

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

5.2.4. Sex *

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

5.2.5. Family name(s) at birth

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

5.2.6. Forename(s) at birth

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

5.2.7. PIN of the person in each institution

[ CC ]

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

5.2.7.1.1. Country *

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

5.2.7.1.2. Personal Identification Number (PIN) *

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

5.2.7.1.3. Sector

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

5.2.7.1.4. Institution

[ CC ]

5.2.7.1.4.1. Institution ID *

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

5.2.7.1.4.2. Institution Name *

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

5.2.7.1.Personal Identification Number(s)

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

[ CC ]

5.2.8.1. Place of birth

[ CC ]

5.2.8.1.1. Town *

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

5.2.8.1.2. Region

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

5.2.8.1.3. Country *

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

5.2.8.2. Father's family name at birth

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

5.2.8.3. Forename of father

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

5.2.8.4. Mother's family name at birth

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

5.2.8.5. Forename of mother

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

5.3. Additional information about nationality [ SC ]

5.3.1. Nationalities [ SC ]

5.3.1.1. Nationality *

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

5.3.1.2. Since

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

5.3.1.Nationalities

5.4. Addresses of the person

[ SC ]

5.4.1. Address of the Person

[ SC ]

5.4.1.1. Type of address

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

5.4.1.2. Address

[ CC ]

5.4.1.2.1. Street

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

5.4.1.2.2. Building Name

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

5.4.1.2.3. Town *

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

5.4.1.2.4. Postal Code

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

5.4.1.2.5. Region

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

5.4.1.2.6. Country *

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

5.4.1.Address of the Person

5.5. Contact Details [ CC ]

5.5.1. Telephone Numbers [ CC ]

5.5.1.1. Telephone Number [ CC ]

5.5.1.1.1. Type

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

5.5.1.1.2. Number *

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

5.5.1.1.Telephone Number

5.5.2. Email Addresses [ CC ]

5.5.2.1. Email Address [ CC ]

5.5.2.1.1. Email Address

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

5.5.2.1.Email Address

5.6. Coverage by social security scheme [ SC ]

5.6.1. Periods Covered by security scheme in sending Member State

[ SC ]

5.6.1.1. Period

[ CC ]

5.6.1.1.1. Start Date *

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

5.6.1.1.2. End Date *

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

5.6.1.1.Period

5.6.2. Periods Not covered [ SC ]

5.6.2.1. Period Not Covered

[ CC ]

5.6.2.1.1. Start Date *

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

5.6.2.1.2. End Date *

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

5.6.2.1.Period Not Covered

5.6.3. Periods of Entitlement [ SC ]

Entitlement to Family Benefits, if yes [ SC ]

If no entitlement, choose one reason [ SC ]

5.6.3.1.1. Period Entitlement Family Benefits [ SC ]

5.6.3.1.1.1. Period of Entitlement to family benefit

[ CC ]

5.6.3.1.1.1.1. Start Date *

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

5.6.3.1.1.1.2. End Date *

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

5.6.3.1.1.1.Period of Entitlement to family benefit

5.6.3.2.1. Reason

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

5.6.3.2.2. Other reason

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

5.7. Family relationship of deceased person to the spouse, partner or other person [ SC ]

5.7.1. Relationships [ SC ]

5.7.1.1. Family relationship

[ SC ]

5.7.1.1.1. Family Relationship

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

5.7.1.1.2. Other

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

5.7.1.1.3. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

5.7.1.1.3.1.1. Start date *

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

5.7.1.1.3.1.2. End date *

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

5.7.1.1.3.2.1. Type of Open Period *

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

5.7.1.1.3.2.2. Start date *

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

5.7.1.1.4. Other relationship

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

5.7.1.1.5. Name of person

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

5.7.1.1.6. Date of relationship

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

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

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

5.7.1.1.Family relationship

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)

[ SED ]

7.1. Is the child the claimant?

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

7.2. Child [ SED ]

7.2.1. Child Details * [ CC ]

7.2.1.1. Family name(s) *

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

7.2.1.2. Forename(s) *

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

7.2.1.3. Date of birth *

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

7.2.1.4. Sex *

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

7.2.1.5. Family name(s) at birth

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

7.2.1.6. Forename(s) at birth

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

7.2.1.7. PIN of the person in each institution

[ CC ]

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

7.2.1.7.1.1. Country *

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7.2.1.7.1.2. Personal Identification Number (PIN) *

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7.2.1.7.1.3. Sector

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7.2.1.7.1.4. Institution

[ CC ]

7.2.1.7.1.4.1. Institution ID *

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

7.2.1.7.1.4.2. Institution Name *

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

7.2.1.7.1.Personal Identification Number(s)

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

[ CC ]

7.2.1.8.1. Place of birth

[ CC ]

7.2.1.8.1.1. Town *

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

7.2.1.8.1.2. Region

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

7.2.1.8.1.3. Country *

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

7.2.1.8.2. Father's family name at birth

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

7.2.1.8.3. Forename of father

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

7.2.1.8.4. Mother's family name at birth

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

7.2.1.8.5. Forename of mother

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

7.2.2. Additional information about nationality [ SC ]

7.2.2.1. Nationalities [ SC ]

7.2.2.1.1. Nationality *

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

7.2.2.1.2. Since

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

7.2.2.1.Nationalities

7.2.3. Addresses of the child

[ SC ]

7.2.3.1. Address of the Person

[ SC ]

7.2.3.1.1. Type of address

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

7.2.3.1.2. Address

[ CC ]

7.2.3.1.2.1. Street

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

7.2.3.1.2.2. Building Name

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

7.2.3.1.2.3. Town *

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

7.2.3.1.2.4. Postal Code

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

7.2.3.1.2.5. Region

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

7.2.3.1.2.6. Country *

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

7.2.3.1.Address of the Person

7.2.4. Relationship to claimant, spouse/partner or other person [ SC ]

7.2.4.1. Relationship per child [ SC ]

7.2.4.1.1. Relationship with *

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7.2.4.1.2. Type *

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

7.2.4.1.3. Period of Relationship [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

7.2.4.1.3.1.1. Start date *

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7.2.4.1.3.1.2. End date *

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7.2.4.1.3.2.1. Type of Open Period *

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

7.2.4.1.3.2.2. Start date *

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

7.2.4.1.4. Joint custody

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

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

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

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

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

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

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

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

7.2.4.1.5.4. Is child in the institution

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

7.2.4.1.Relationship per child

8. Additional information

[ SC ]

8.1. Additional information

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F021 - Application for additional benefits Articles 69, 81 of Regulation (EC) No 883/2004; Article 61 of Regulation (EC) No 987/2009

F021 - Application for additional benefits
Articles 69, 81 of Regulation (EC) No 883/2004; Article 61 of Regulation (EC) No 987/2009