Claim for Pre-retirement Benefit

M040 - Claim for Pre-retirement Benefit
Articles 3(1)(i), 66 of Regulation (EC) No 883/2004

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Claimant * [ SED ]

1.1. Person Identification * [ 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

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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) *

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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

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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

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

1.2. Additional information on the 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)

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1.2.2.2. Previous forename(s)

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2. Person employment / self-employment details [ SED ]

2.1. Status of activity [ SED ]

2.1.1. Country

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2.1.2. Person is still pursuing

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2.1.3. Person ceased to pursue [ SED ]

2.1.3.1. Person ceased to pursue

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2.1.3.2. Date

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2.1.4. Person reduced [ SED ]

2.1.4.1. Person reduced

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2.1.4.2. Date

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2.1.5. Person suspended [ SED ]

2.1.5.1. Person suspended

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2.1.5.2. Date

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

2.1.6. Person intends to retire from [ SED ]

2.1.6.1. Person intends to retire from

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2.1.6.2. Date

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2.1.7. Person intends to take up [ SED ]

2.1.7.1. Person intends to take up

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2.1.7.2. Date

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2.1.Status of activity

2.2. If person still pursuing or intends to take up employment or self-employment please state the monthly amount of income from the employment/self-employment in question [ SED ]

2.2.1. Amount

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2.2.2. Currency

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2.3. Country of the last employment or self-employment activity

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2.4. Country which legislation was applicable during last employment or self-employment activity

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

2.5. Last employer details

[ CC ]

2.5.1. Name *

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

2.5.2. Identification numbers

[ CC ]

2.5.2.1. Identification number

[ CC ]

2.5.2.1.1. Number *

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

2.5.2.1.2. Type *

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

2.5.2.1.Identification number

2.5.3. Address

[ CC ]

2.5.3.1. Street

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

2.5.3.2. Building Name

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

2.5.3.3. Town *

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

2.5.3.4. Postal Code

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

2.5.3.5. Region

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

2.5.3.6. Country *

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

2.5.Last employer details

2.6. Reason for termination of the last employment or self-employment [ SED ]

2.6.1. Termination reason of employment

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

2.6.2. Please fill in the following if "Termination reason of employment" = "Other" : [ SED ]

2.6.2.1. Other termination

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

2.6.3. Termination reason of self-employment

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

2.7. Other information on employment or self-employment

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

2.8. The date of termination of the last employment or self-employment

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

3. Person benefit details [ SED ]

3.1. Person benefit details [ SED ]

3.1.1. Benefits

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

3.1.2. Please fill in the following if "Benefits" = "Other benefit" : [ SED ]

3.1.2.1. Other benefit

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

3.1.3. Status

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

3.1.4. Institution

[ CC ]

3.1.4.1. Institution ID *

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

3.1.4.2. Institution Name *

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

3.1.5. Period of benefits payment [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

3.1.5.1.1. Start date *

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

3.1.5.1.2. End date *

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

3.1.5.2.1. Type of Open Period *

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3.1.5.2.2. Start date *

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

3.1.Person benefit details

4. Information on representative/legal guardian [ SC ]

4.1. Status

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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 *

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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. Miscellaneous * [ SED ]

6.1. Date of claim *

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

6.2. Remarks

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

7. Additional Information [ SC ]

7.1. Additional Information

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8. Please find attached following document(s) [ SED ]

8.1. Attached document(s)

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8.2. Other document(s)

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M040 - Claim for Pre-retirement Benefit Articles 3(1)(i), 66 of Regulation (EC) No 883/2004

M040 - Claim for Pre-retirement Benefit
Articles 3(1)(i), 66 of Regulation (EC) No 883/2004