Information on pension supplement

P13000 - Information on pension supplement
Article 58 of Regulation (EC) No 883/2004

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Local case numbers [ CC ]

1.1. Local Case Number [ CC ]

1.1.1. Country *

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1.1.2. Case number *

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

1.1.3. Institution [ CC ]

1.1.3.1. Institution ID *

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

1.1.3.2. Institution Name *

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

1.1.Local Case Number

2. Insured 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 *

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2.1.5. Family name(s) at birth

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2.1.6. Forename(s) at birth

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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 *

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2.1.7.1.2. Personal Identification Number (PIN) *

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2.1.7.1.3. Sector

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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 the person [ SC ]

2.2.1. Additional Information on the person [ SC ]

2.2.1.1. Nationality

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2.2.1.2. Previous family name(s)

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

2.2.1.3. Previous forename(s)

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

2.2.2. Address [ CC ]

2.2.2.1. Street

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2.2.2.2. Building Name

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

2.2.2.3. Town *

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

2.2.2.4. Postal Code

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

2.2.2.5. Region

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

2.2.2.6. Country *

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2.2.3. Contact information on the person [ CC ]

2.2.3.1. Telephone Numbers [ CC ]

2.2.3.1.1. Telephone Number [ CC ]

2.2.3.1.1.1. Type

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2.2.3.1.1.2. Number *

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

2.2.3.1.1.Telephone Number

2.2.3.2. Email Addresses [ CC ]

2.2.3.2.1. Email Address [ CC ]

2.2.3.2.1.1. Email Address

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

2.2.3.2.1.Email Address

3. Recipient of survivor's pension [ SC ]

3.1. Person identification * [ CC ]

3.1.1. Family name(s) *

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

3.1.2. Forename(s) *

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

3.1.3. Date of birth *

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

3.1.4. Sex *

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3.1.5. Family name(s) at birth

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

3.1.6. Forename(s) at birth

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

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

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

3.1.7.1.1. Country *

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3.1.7.1.2. Personal Identification Number (PIN) *

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

3.1.7.1.3. Sector

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

3.1.7.1.4. Institution [ CC ]

3.1.7.1.4.1. Institution ID *

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

3.1.7.1.4.2. Institution Name *

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

3.1.7.1.Personal Identification Number(s)

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

3.1.8.1. Place of birth [ CC ]

3.1.8.1.1. Town *

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

3.1.8.1.2. Region

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

3.1.8.1.3. Country *

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

3.1.8.2. Father's family name at birth

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

3.1.8.3. Forename of father

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

3.1.8.4. Mother's family name at birth

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

3.1.8.5. Forename of mother

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

3.2. Additional information on the person [ SC ]

3.2.1. Additional information on the person [ SC ]

3.2.1.1. Nationality

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3.2.1.2. Previous family name(s)

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

3.2.1.3. Previous forename(s)

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

3.2.2. Address [ CC ]

3.2.2.1. Street

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

3.2.2.2. Building Name

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

3.2.2.3. Town *

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

3.2.2.4. Postal Code

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

3.2.2.5. Region

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

3.2.2.6. Country *

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

3.2.3. Contact information on the person [ CC ]

3.2.3.1. Telephone Numbers [ CC ]

3.2.3.1.1. Telephone Number [ CC ]

3.2.3.1.1.1. Type

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

3.2.3.1.1.2. Number *

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

3.2.3.1.1.Telephone Number

3.2.3.2. Email Addresses [ CC ]

3.2.3.2.1. Email Address [ CC ]

3.2.3.2.1.1. Email Address

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

3.2.3.2.1.Email Address

4. Type of pension in the sending institution [ SED ]

4.1. Type of pension in the sending institution

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5. Reference to the person [ SC ]

5.1. This reply is made with reference to the person named in

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6. Information on supplement [ SED ]

6.1. Details of the awarded supplement [ SED ]

6.1.1. Amount of the supplement [ SC ]

6.1.1.1. Amount

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6.1.1.2. Currency

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6.1.1.3. Amount effective since

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6.1.1.4. Payment frequency

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6.1.1.5. Please fill in the following if "Payment frequency" = "Other" : [ SC ]

6.1.1.5.1. Other payment frequency

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6.1.2. Payment of supplement [ SED ]

6.1.2.1. Supplement payable from

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6.1.2.2. Supplement payable to

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6.1.Details of the awarded supplement

6.2. Information on amount change in supplement [ SED ]

6.2.1. Date of change of the amount of supplement

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6.2.2. Amount before change

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6.2.3. Amount after change

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6.2.Information on amount change in supplement

6.3. End date of entitlement to supplement

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6.4. Reasons for not awarding the supplement

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

6.5. Suspension of supplement [ SED ]

6.5.1. Date of suspension

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

6.5.2. Reason for supplement suspension

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7. Additional information [ SC ]

7.1. Additional information

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8. Attachments [ SC ]

8.1. List of attachments

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P13000 - Information on pension supplement Article 58 of Regulation (EC) No 883/2004

P13000 - Information on pension supplement
Article 58 of Regulation (EC) No 883/2004