Reply to request for information

H002 - Reply to request for information
Article 76 of Regulation (EC) No 883/2004

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Reply to request for information * [ SED ]

Person* [ SED ]

Employer* [ SED ]

Reimbursement Bulk SED* [ SED ]

1.1.1. Person identification * [ SC ]

1.1.1.1. Person Identification * [ CC ]

1.1.1.1.1. Family name(s) *

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

1.1.1.1.2. Forename(s) *

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

1.1.1.1.3. Date of birth *

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

1.1.1.1.4. Sex *

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

1.1.1.1.5. Family name(s) at birth

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

1.1.1.1.6. Forename(s) at birth

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

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

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

1.1.1.1.7.1.1. Country *

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

1.1.1.1.7.1.2. Personal Identification Number (PIN) *

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

1.1.1.1.7.1.3. Sector

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

1.1.1.1.7.1.4. Institution [ CC ]

1.1.1.1.7.1.4.1. Institution ID *

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

1.1.1.1.7.1.4.2. Institution Name *

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

1.1.1.1.7.1.Personal Identification Number(s)

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

1.1.1.1.8.1. Place of birth [ CC ]

1.1.1.1.8.1.1. Town *

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

1.1.1.1.8.1.2. Region

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

1.1.1.1.8.1.3. Country *

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

1.1.1.1.8.2. Father's family name at birth

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

1.1.1.1.8.3. Forename of father

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

1.1.1.1.8.4. Mother's family name at birth

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

1.1.1.1.8.5. Forename of mother

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

1.1.1.2. Additional information on the person [ SC ]

1.1.1.2.1. Nationality

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

1.1.1.2.2. Status of the person

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

1.1.1.2.3. Please fill in if "Status of the person" = "Other": [ SC ]

1.1.1.2.3.1. Other

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

1.1.2. Address of the person [ SC ]

1.1.2.1. Address of the person [ SC ]

1.1.2.1.1. Type of Address

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

1.1.2.1.2. Address [ CC ]

1.1.2.1.2.1. Street

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

1.1.2.1.2.2. Building Name

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

1.1.2.1.2.3. Town *

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

1.1.2.1.2.4. Postal Code

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

1.1.2.1.2.5. Region

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

1.1.2.1.2.6. Country *

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

1.1.2.1.Address of the person

1.1.3. Information for identification of the person [ SED ]

1.1.3.1. Person [ SED ]

1.1.3.1.1. Family name(s)

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

1.1.3.1.2. Forename(s)

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

1.1.3.1.3. Birth date

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

1.1.3.1.4. Sex

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

1.1.3.1.5. Family name(s) at birth

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

1.1.3.1.6. Forename(s) at birth

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

1.1.3.1.7. Place of birth [ CC ]

1.1.3.1.7.1. Town *

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

1.1.3.1.7.2. Region

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

1.1.3.1.7.3. Country *

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

1.1.3.1.8. Father's family name at birth

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

1.1.3.1.9. Forename of father

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

1.1.3.1.10. Mother's family name at birth

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

1.1.3.1.11. Forename of mother

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

1.1.3.1.12. Previous family name(s)

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

1.1.3.1.13. Previous forename(s)

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

1.1.4. Sector PIN (Personal Identification Number of the sending institution) [ SED ]

1.1.4.1. Sector PIN (Personal Identification Number of the sending institution) [ SED ]

1.1.4.1.1. All

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

1.1.4.1.2. Sickness in cash

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

1.1.4.1.3. Sickness in kind

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

1.1.4.1.4. Pension

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

1.1.4.1.5. Unemployment

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

1.1.4.1.6. Occupational disease and accident at work, benefits in cash

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

1.1.4.1.7. Occupational disease and accident at work, benefits in kind

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

1.1.4.1.8. Family benefits

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

1.1.4.1.9. Recovery

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

1.1.4.1.10. National Tax number

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

1.1.4.1.11. Other sector PIN

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

1.1.4.2. Please fill in the following if "Sector PIN"="Other sector PIN": [ SED ]

1.1.4.2.1. Description of other sector

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

1.1.5. Positive reply to requested information [ SED ]

1.1.5.1. We are enclosing [ SED ]

1.1.5.1.1. The following document(s)

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

1.1.5.1.2. The following information

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

1.1.5.1.3. The following SED(s)

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

1.1.6. Negative reply to requested information [ SED ]

1.1.6.1. We are unable to send [ SED ]

1.1.6.1.1. The following document(s)

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

1.1.6.1.2. The following information

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

1.1.6.1.3. The following SED(s)

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

1.1.6.1.4. Reasons

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

1.1.6.1.We are unable to send

1.1.7. Additional information [ SC ]

1.1.7.1. Additional information

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

1.1.8. Please find attached the following documents: [ SC ]

1.1.8.1. Predefined Documents

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

1.1.8.2. Other Documents Attached [ SC ]

1.1.8.2.1. Other Document [ SC ]

1.1.8.2.1.1. Document

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

1.1.8.2.1.Other Document

1.2.1. Employer * [ CC ]

1.2.1.1. Name *

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

1.2.1.2. Identification numbers [ CC ]

1.2.1.2.1. Identification number [ CC ]

1.2.1.2.1.1. Number *

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

1.2.1.2.1.2. Type *

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

1.2.1.2.1.Identification number

1.2.1.3. Address [ CC ]

1.2.1.3.1. Street

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

1.2.1.3.2. Building Name

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

1.2.1.3.3. Town *

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

1.2.1.3.4. Postal Code

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

1.2.1.3.5. Region

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

1.2.1.3.6. Country *

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

1.2.2. Positive reply to requested information [ SED ]

1.2.2.1. We are enclosing [ SED ]

1.2.2.1.1. The following document(s)

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

1.2.2.1.2. The following information

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

1.2.2.1.3. The following SED(s)

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

1.2.3. Negative reply to requested information [ SED ]

1.2.3.1. We are unable to send [ SED ]

1.2.3.1.1. The following document(s)

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

1.2.3.1.2. The following information

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

1.2.3.1.3. The following SED(s)

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

1.2.3.1.4. Reasons

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

1.2.3.1.We are unable to send

1.2.4. Additional information [ SC ]

1.2.4.1. Additional information

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

1.2.5. Please find attached the following documents: [ SC ]

1.2.5.1. Predefined Documents

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

1.2.5.2. Other Documents Attached [ SC ]

1.2.5.2.1. Other Document [ SC ]

1.2.5.2.1.1. Document

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

1.2.5.2.1.Other Document

1.3.1. Reimbursement identification * [ SC ]

1.3.1.1. Reimbursement Request ID *

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

1.3.2. Positive reply to requested information [ SED ]

1.3.2.1. We are enclosing [ SED ]

1.3.2.1.1. The following document(s)

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

1.3.2.1.2. The following information

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

1.3.2.1.3. The following SED(s)

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

1.3.3. Negative reply to requested information [ SED ]

1.3.3.1. We are unable to send [ SED ]

1.3.3.1.1. The following document(s)

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

1.3.3.1.2. The following information

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

1.3.3.1.3. The following SED(s)

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

1.3.3.1.4. Reasons

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

1.3.3.1.We are unable to send

1.3.4. Additional information [ SC ]

1.3.4.1. Additional information

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

1.3.5. Please find attached the following documents: [ SC ]

1.3.5.1. Predefined Documents

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

1.3.5.2. Other Documents Attached [ SC ]

1.3.5.2.1. Other Document [ SC ]

1.3.5.2.1.1. Document

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

1.3.5.2.1.Other Document

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H002 - Reply to request for information Article 76 of Regulation (EC) No 883/2004

H002 - Reply to request for information
Article 76 of Regulation (EC) No 883/2004