Claim for Death Grant

M030 - Claim for Death Grant
Articles 42, 43 of Regulation (EC) No 883/04; Article 42 of Regulation (EC) No 987/09

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Deceased person * [ SED ]

1.1. Deceased Person *

[ CC ]

1.1.1. Family name(s) *

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

1.1.2. Forename(s) *

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

1.1.3. Date of birth *

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

1.1.4. Sex *

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

1.1.5. Family name(s) at birth

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

1.1.6. Forename(s) at birth

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

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 *

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

1.1.7.1.2. Personal Identification Number (PIN) *

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

1.1.7.1.3. Sector

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

1.1.7.1.4. Institution

[ CC ]

1.1.7.1.4.1. Institution ID *

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

1.1.7.1.4.2. Institution Name *

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

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 *

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

1.1.8.1.2. Region

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

1.1.8.1.3. Country *

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

1.1.8.2. Father's family name at birth

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

1.1.8.3. Forename of father

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

1.1.8.4. Mother's family name at birth

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

1.1.8.5. Forename of mother

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

1.2. Additional information on deceased person [ SED ]

1.2.1. Nationality

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

1.2.2. Previous name(s) [ SC ]

1.2.2.1. Previous family name(s)

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

1.2.2.2. Previous forename(s)

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

1.2.3. Address of the deceased person before death

[ CC ]

1.2.3.1. Street

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

1.2.3.2. Building Name

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

1.2.3.3. Town *

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

1.2.3.4. Postal Code

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

1.2.3.5. Region

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

1.2.3.6. Country *

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

1.2.4. Status of the deceased person before death

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

1.2.5. Please fill in the following if "Status of the deceased person before death" = "Other" [ SED ]

1.2.5.1. Other status

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

1.2.6. Status

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

2. Claimant * [ SED ]

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 on claimant [ SED ]

2.2.1. Nationality

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

2.2.2. Previous name(s) [ SC ]

2.2.2.1. Previous family name(s)

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

2.2.2.2. Previous forename(s)

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

2.2.3. Status of the claimant

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

2.2.4. Please fill in the following if "Status of the claimant" = "Other" [ SED ]

2.2.4.1. Other status

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

2.2.5. Status

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

2.2.6. Relationship to the deceased person [ SED ]

2.2.6.1. Relationship to the deceased person

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

2.2.6.2. Please fill in the following if "Relationship to the deceased person" = "Other" : [ SED ]

2.2.6.2.1. Other relationship

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

2.2.6.3. The deceased person was dependant of the claimant

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

2.2.6.4. The claimant was dependant of the deceased person

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

2.3. Other Claimant [ SED ]

2.3.1. If the claimant is

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

2.3.2. Please fill in: [ SED ]

2.3.2.1. Name of legal person/undertaker

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

2.3.2.2. Identification of legal person/undertaker [ SED ]

2.3.2.2.1. Registration number

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

2.3.2.2.2. Social security number

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

2.3.2.2.3. Fiscal number

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

2.3.3. Name of person entitled to represent legal person/undertaker [ CC ]

2.3.3.1. Family name(s)

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

2.3.3.2. Forename(s)

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

2.4. Address

[ CC ]

2.4.1. Street

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

2.4.2. Building Name

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

2.4.3. Town *

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

2.4.4. Postal Code

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

2.4.5. Region

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

2.4.6. Country *

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

3. Additional information on the claim for death grant * [ SED ]

3.1. Details of Death * [ SED ]

3.1.1. Death date of the deceased person *

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

3.1.2. Place of death

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

3.2. Date of the claim *

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

3.3. Legislation of sending institution *

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

3.4. The Claimant *

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

3.5. The Claimant

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

4. Information on representative/legal guardian [ SC ]

4.1. Status

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

4.2. Information on the representative/legal guardian [ SC ]

4.2.1. Name

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

4.2.2. Address

[ CC ]

4.2.2.1. Street

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

4.2.2.2. Building Name

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

4.2.2.3. Town *

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

4.2.2.4. Postal Code

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

4.2.2.5. Region

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

4.2.2.6. Country *

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

5. Information on payment * [ SC ]

5.1. Payment to *

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

5.2. Bank details [ CC ]

SEPA account* [ CC ]

Non-SEPA account* [ CC ]

5.2.1.1. IBAN *

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

5.2.1.2. BIC-SWIFT

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

5.2.2.1. Account number *

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

5.2.2.2. BIC-SWIFT *

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

5.2.2.3. Bank Name *

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

5.2.2.4. Bank Address *

[ CC ]

5.2.2.4.1. Street

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

5.2.2.4.2. Building Name

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

5.2.2.4.3. Town *

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

5.2.2.4.4. Postal Code

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

5.2.2.4.5. Region

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

5.2.2.4.6. Country *

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

6. Additional Information [ SC ]

6.1. Additional Information

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

7. Please find attached following document(s) [ SC ]

7.1. Attached document(s)

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

7.2. Other document(s)

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

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M030 - Claim for Death Grant Articles 42, 43 of Regulation (EC) No 883/04; Article 42 of Regulation (EC) No 987/09

M030 - Claim for Death Grant
Articles 42, 43 of Regulation (EC) No 883/04; Article 42 of Regulation (EC) No 987/09