Country specific information

P3000_IT - Country specific information - Italy
Articles 45(4), 46(1), 47(4-5) of Regulation (EC) No 987/2009

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 *

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

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 *

[ 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 the person [ SC ]

2.2.1. Additional information on the person [ SC ]

2.2.1.1. Nationality

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

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

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

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 *

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

3. Claimant (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 *

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

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 *

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

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

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

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}}

4. Additional information for old age pension claim [ SED ]

4.1. Additional information on the insured person [ SED ]

4.1.1. Ex-serviceman

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

4.2. Additional information on the insured person's employment and self-employment details [ SED ]

4.2.1. The insured person's employment type

[ SED ]

4.2.1.1. Employment type

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

4.2.1.2. Please fill in the following if "Employment type" = "Employee" or "Employment type = "Civil servant" [ SED ]

4.2.1.2.1. Employment activity [ SED ]

4.2.1.2.1.1. Years carrying employment activity

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

4.2.1.2.1.2. Income amounts [ SED ]

4.2.1.2.1.2.1. Income amount [ SC ]

4.2.1.2.1.2.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.2.1.2.1.2.1.2. Currency

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

4.2.1.2.1.2.1.3. Amount effective since

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

4.2.1.2.1.2.1.4. Payment frequency

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

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

4.2.1.2.1.2.1.5.1. Other payment frequency

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

4.2.1.2.1.2.1.Income amount

4.2.1.3. Please fill in the following if "Employment type" = "Self-employed" [ SED ]

4.2.1.3.1. Business volume

[ SED ]

4.2.1.3.1.1. Business volume

[ PRIM ] {{metaSection.businessVolume.$$error}} {{metaSection.businessVolume.$$warning}}

4.2.1.3.1.2. Annual income from self-employment

[ PRIM ] {{metaSection.annualIncomeFromSelfEmployment.$$error}} {{metaSection.annualIncomeFromSelfEmployment.$$warning}}

4.2.1.4. Please fill in the following if "Employment type" = "Professional" [ SED ]

4.2.1.4.1. Professional income amounts [ SED ]

4.2.1.4.1.1. Professional income amount [ SC ]

4.2.1.4.1.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.2.1.4.1.1.2. Currency

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

4.2.1.4.1.1.3. Amount effective since

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

4.2.1.4.1.1.4. Payment frequency

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

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

4.2.1.4.1.1.5.1. Other payment frequency

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

4.2.1.4.1.1.Professional income amount

4.2.1.5. Profession

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

4.2.1.6. Qualification

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

4.2.2. Other resources - sources of income

[ SC ]

4.2.2.1. Other resources - sources of income

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

4.2.2.2. Type of other resources - sources of income

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

4.2.2.3. Amount [ SC ]

4.2.2.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.2.2.3.2. Currency

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

4.2.2.3.3. Amount effective since

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

4.2.2.3.4. Payment frequency

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

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

4.2.2.3.5.1. Other payment frequency

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

4.2.2.3.Amount

4.2.3. Insured person states no income

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

4.2.4. Compulsory pension insurance cover entailed

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

4.2.5. Retirement intended

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

4.2.6. Gainful employment intended

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

4.2.7. Income type

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

4.2.8. Raising child

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

4.3. Additional information on the insured person's benefit details [ SED ]

4.3.1. Entitlement to sickness benefits in kind

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

4.3.2. Fit for work declaration of the insured person

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

4.3.3. Constant attendance declaration of the insured person

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

4.3.4. Functional capacity declaration of the insured person

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

4.3.5. Sufficient means of subsistence declaration of the insured person

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

4.3.6. Assistance benefit

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

4.3.7. Benefits with additional benefits

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

4.4. Additional information on the spouse [ SED ]

4.4.1. Gainful employment

[ SED ]

4.4.1.1. Gainful employment

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

4.4.1.2. Amounts [ SC ]

4.4.1.2.1. Amount [ SC ]

4.4.1.2.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.4.1.2.1.2. Currency

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

4.4.1.2.1.3. Amount effective since

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

4.4.1.2.1.4. Payment frequency

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

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

4.4.1.2.1.5.1. Other payment frequency

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

4.4.1.2.1.Amount

4.4.2. Fit for work

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

4.4.3. Pension recipient [ SC ]

4.4.3.1. Pension recipient [ SC ]

4.4.3.1.1. Pension recipient

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

4.4.3.1.2. Pension type

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

4.4.3.1.3. Pension number

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

4.4.3.2. Institution [ SC ]

4.4.3.2.1. Institution [ CC ]

4.4.3.2.1.1. Country *

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

4.4.3.2.1.2. Personal Identification Number (PIN) *

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

4.4.3.2.1.3. Sector

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

4.4.3.2.1.4. Institution

[ CC ]

4.4.3.2.1.4.1. Institution ID *

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

4.4.3.2.1.4.2. Institution Name *

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

4.4.3.3. Amounts [ SC ]

4.4.3.3.1. Amount [ SC ]

4.4.3.3.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.4.3.3.1.2. Currency

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

4.4.3.3.1.3. Amount effective since

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

4.4.3.3.1.4. Payment frequency

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

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

4.4.3.3.1.5.1. Other payment frequency

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

4.4.3.3.1.Amount

4.4.3.4. Start date of benefits payment

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

4.4.3.5. End date of benefits payment

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

4.4.3.6. Pension based on period of insurance of the

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

4.4.3.Pension recipient

4.4.4. Other benefits received by the spouse

[ SC ]

4.4.4.1. Other benefits received by the spouse

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

4.4.4.2. Type of other benefits

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

4.4.4.3. Amount [ SC ]

4.4.4.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.4.4.3.2. Currency

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

4.4.4.3.3. Amount effective since

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

4.4.4.3.4. Payment frequency

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

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

4.4.4.3.5.1. Other payment frequency

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

4.4.4.3.Amount

4.4.5. Other resources - sources of income

[ SC ]

4.4.5.1. Other resources - sources of income

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

4.4.5.2. Type of other resources - sources of income

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

4.4.5.3. Amount [ SC ]

4.4.5.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.4.5.3.2. Currency

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

4.4.5.3.3. Amount effective since

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

4.4.5.3.4. Payment frequency

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

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

4.4.5.3.5.1. Other payment frequency

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

4.4.5.3.Amount

4.5. Additional information on the children of the insured person

[ SED ]

4.5.1. Additional information on the children of the insured person [ SC ]

4.5.1.1. Family name(s)

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

4.5.1.2. Forename(s)

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

4.5.1.3. Family Status

[ SC ]

4.5.1.3.1. Family Status

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

4.5.1.3.2. Family status date

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

4.5.1.3.Family Status

4.5.2. Child

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

4.5.3. Benefits for child

[ SC ]

4.5.3.1. Benefits for child

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

4.5.3.2. Type of benefit

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

4.5.3.3. Amount [ SC ]

4.5.3.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

4.5.3.3.2. Currency

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

4.5.3.3.3. Amount effective since

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

4.5.3.3.4. Payment frequency

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

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

4.5.3.3.5.1. Other payment frequency

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

4.5.3.3.Amount

4.5.4. Address

[ CC ]

4.5.4.1. Street

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

4.5.4.2. Building Name

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

4.5.4.3. Town *

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

4.5.4.4. Postal Code

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

4.5.4.5. Region

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

4.5.4.6. Country *

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

4.5.Additional information on the children of the insured person

4.6. Additional information on ascendants and other family members [ SED ]

4.6.1. Additional information on ascendants and other family members [ SED ]

4.6.1.1. Surname

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

4.6.1.2. Forename(s)

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

4.6.1.3. Date of birth

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

4.6.1.4. Relationship

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

4.6.1.5. Address

[ CC ]

4.6.1.5.1. Street

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

4.6.1.5.2. Building Name

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

4.6.1.5.3. Town *

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

4.6.1.5.4. Postal Code

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

4.6.1.5.5. Region

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

4.6.1.5.6. Country *

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

4.6.1.6. Ascendant or other family member

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

4.6.1.Additional information on ascendants and other family members

4.7. Unable to provide the requested information in this section

[ SC ]

4.7.1. Is the requested information available?

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

4.7.2. Please fill in the following if the above is answered "No". [ SC ]

4.7.2.1. Reason

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

5. Additional information for survivor's pension claim [ SED ]

5.1. Additional information on the claimant [ SED ]

5.1.1. Dependent from the deceased insured person

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

5.1.2. Ex-serviceman

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

5.1.3. Both parents deceased

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

5.1.4. Fit for work declaration of the claimant

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

5.1.5. The claimant is unfit for work

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

5.1.6. Constant attendance declaration of the claimant

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

5.2. Additional information on the claimant's employment and self-employment details [ SED ]

5.2.1. Employment and self-employment details [ SED ]

5.2.1.1. Employment and self-employment details [ SED ]

5.2.1.1.1. Claimant employment [ SED ]

5.2.1.1.1.1. Employment type

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

5.2.1.1.1.2. Please fill in the following if "Employment type" = "Employee" or "Employment type = "Civil servant" [ SED ]

5.2.1.1.1.2.1. Employment activity [ SED ]

5.2.1.1.1.2.1.1. Years carrying employment activity

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

5.2.1.1.1.2.1.2. Income amounts [ SED ]

5.2.1.1.1.2.1.2.1. Income amount [ SC ]

5.2.1.1.1.2.1.2.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

5.2.1.1.1.2.1.2.1.2. Currency

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

5.2.1.1.1.2.1.2.1.3. Amount effective since

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

5.2.1.1.1.2.1.2.1.4. Payment frequency

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

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

5.2.1.1.1.2.1.2.1.5.1. Other payment frequency

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

5.2.1.1.1.2.1.2.1.Income amount

5.2.1.1.1.3. Business volume

[ SED ]

5.2.1.1.1.3.1. Business volume

[ PRIM ] {{metaSection.businessVolume.$$error}} {{metaSection.businessVolume.$$warning}}

5.2.1.1.1.3.2. Annual income from self-employment

[ PRIM ] {{metaSection.annualIncomeFromSelfEmployment.$$error}} {{metaSection.annualIncomeFromSelfEmployment.$$warning}}

5.2.1.1.1.4. Please fill in the following if "Employment type" = "Professional" [ SED ]

5.2.1.1.1.4.1. Professional income amounts [ SED ]

5.2.1.1.1.4.1.1. Professional income amount [ SC ]

5.2.1.1.1.4.1.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

5.2.1.1.1.4.1.1.2. Currency

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

5.2.1.1.1.4.1.1.3. Amount effective since

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

5.2.1.1.1.4.1.1.4. Payment frequency

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

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

5.2.1.1.1.4.1.1.5.1. Other payment frequency

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

5.2.1.1.1.4.1.1.Professional income amount

5.2.1.1.2. Other resources - sources of income

[ SC ]

5.2.1.1.2.1. Other resources - sources of income

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

5.2.1.1.2.2. Type of other resources - sources of income

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

5.2.1.1.2.3. Amount [ SC ]

5.2.1.1.2.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

5.2.1.1.2.3.2. Currency

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

5.2.1.1.2.3.3. Amount effective since

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

5.2.1.1.2.3.4. Payment frequency

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

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

5.2.1.1.2.3.5.1. Other payment frequency

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

5.2.1.1.2.3.Amount

5.2.1.1.Employment and self-employment details

5.3. Additional information on the claimant's benefit details [ SED ]

5.3.1. Basic benefit

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

5.3.2. Assistance benefit

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

5.3.3. Educational training benefit

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

5.3.4. Benefit covering expenses care for children

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

5.4. Additional information on the deceased insured person's benefit details [ SED ]

5.4.1. Ex-serviceman

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

5.4.2. Receiver of a pension at the date of marriage

[ SED ]

5.4.2.1. Receiver of a pension at the date of marriage

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

5.4.2.2. Type of pension scheme

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

5.4.3. Survivor insurance

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

5.4.4. End date of pension payment

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

5.4.5. Pension based on period of

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

5.5. Additional information on the deceased insured person's employment details [ SED ]

5.5.1. Gainful employment

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

5.5.2. Death caused by the claimant [ SED ]

5.5.2.1. Death caused by the claimant

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

5.5.2.2. Legal action taken against the responsible party

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

5.5.2.3. Total compensation received

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

5.5.2.4. Date of deletion from the register

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

5.6. Additional information on the children of the deceased insured person

[ SED ]

5.6.1. Name of the child

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

5.6.2. Child

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

5.6.3. Tax identification number

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

5.6.4. Child invalidity

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

5.6.5. Child under 26 still at school

[ ENUM ] {{metaSection.childUnder26StillAtSchoolIndicator.$$error}} {{metaSection.childUnder26StillAtSchoolIndicator.$$warning}}

5.6.Additional information on the children of the deceased insured person

5.7. Additional information on ascendants and other family members [ SED ]

5.7.1. Additional information on ascendants and other family members [ SED ]

5.7.1.1. Surname

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

5.7.1.2. Forename(s)

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

5.7.1.3. Date of birth

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

5.7.1.4. Relationship

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

5.7.1.5. Address

[ CC ]

5.7.1.5.1. Street

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

5.7.1.5.2. Building Name

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

5.7.1.5.3. Town *

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

5.7.1.5.4. Postal Code

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

5.7.1.5.5. Region

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

5.7.1.5.6. Country *

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

5.7.1.6. Ascendant or other family member

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

5.7.1.Additional information on ascendants and other family members

5.8. Unable to provide the requested information in this section

[ SC ]

5.8.1. Is the requested information available?

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

5.8.2. Please fill in the following if the above is answered "No". [ SC ]

5.8.2.1. Reason

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

6. Additional information for invalidity pension claim [ SED ]

6.1. Additional information on the insured person [ SED ]

6.1.1. Ex-service man

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

6.1.2. Insurance against work incapacity

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

6.1.3. Rehabilitation courses

[ SED ]

6.1.3.1. Rehabilitation courses

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

6.1.3.2. Please fill in the following if "Rehabilitation courses" = "Occupational" : [ SED ]

6.1.3.2.1. Occupation

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

6.1.4. Profession

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

6.1.5. Qualification

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

6.2. Additional information on the insured person's employment and self-employment details [ SED ]

6.2.1. Employment and self-employment details [ SED ]

6.2.1.1. Claimant employment [ SED ]

6.2.1.1.1. Employment type

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

Please fill in the following if "Employment type" = "Employee" or "Employment type = "Civil servant" [ SED ]

Please fill in the following if "Employment type" = "Self-employed" [ SED ]

Please fill in the following if "Employment type" = "Professional" [ SED ]

6.2.1.1.2.1. Employment activity [ SED ]

6.2.1.1.2.1.1. Years carrying employment activity

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

6.2.1.1.2.1.2. Amounts [ SED ]

6.2.1.1.2.1.2.1. Amount [ SC ]

6.2.1.1.2.1.2.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

6.2.1.1.2.1.2.1.2. Currency

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

6.2.1.1.2.1.2.1.3. Amount effective since

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

6.2.1.1.2.1.2.1.4. Payment frequency

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

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

6.2.1.1.2.1.2.1.5.1. Other payment frequency

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

6.2.1.1.2.1.2.1.Amount

6.2.1.1.3.1. Business volume

[ SED ]

6.2.1.1.3.1.1. Business volume

[ PRIM ] {{metaSection.businessVolume.$$error}} {{metaSection.businessVolume.$$warning}}

6.2.1.1.3.1.2. Annual income from self-employment

[ PRIM ] {{metaSection.annualIncomeFromSelfEmployment.$$error}} {{metaSection.annualIncomeFromSelfEmployment.$$warning}}

6.2.1.1.4.1. Professional income amounts [ SED ]

6.2.1.1.4.1.1. Professional income amount [ SC ]

6.2.1.1.4.1.1.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

6.2.1.1.4.1.1.2. Currency

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

6.2.1.1.4.1.1.3. Amount effective since

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

6.2.1.1.4.1.1.4. Payment frequency

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

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

6.2.1.1.4.1.1.5.1. Other payment frequency

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

6.2.1.1.4.1.1.Professional income amount

6.2.1.2. Other resources - sources of income

[ SC ]

6.2.1.2.1. Other resources - sources of income

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

6.2.1.2.2. Type of other resources - sources of income

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

6.2.1.2.3. Amount [ SC ]

6.2.1.2.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

6.2.1.2.3.2. Currency

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

6.2.1.2.3.3. Amount effective since

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

6.2.1.2.3.4. Payment frequency

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

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

6.2.1.2.3.5.1. Other payment frequency

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

6.2.1.2.3.Amount

6.2.1.3. Insured person states no income

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

6.2.1.4. Employer [ SC ]

6.2.1.4.1. If you have information from the employee, please fill in the following: [ SC ]

6.2.1.4.1.1. Identification of the employer, by the employee

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

6.2.1.4.1.2. Identification of the employer, by the employee [ SC ]

6.2.1.4.1.2.1. Name *

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

6.2.1.4.1.2.2. Address

[ CC ]

6.2.1.4.1.2.2.1. Street

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

6.2.1.4.1.2.2.2. Building Name

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

6.2.1.4.1.2.2.3. Town *

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

6.2.1.4.1.2.2.4. Postal Code

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

6.2.1.4.1.2.2.5. Region

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

6.2.1.4.1.2.2.6. Country *

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

6.2.1.4.2. If you have information from the employer, please fill in the following: [ SC ]

6.2.1.4.2.1. Identification of the employer, by the employer

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

6.2.1.4.2.2. Identification of the employer, by the employer [ SC ]

6.2.1.4.2.2.1. Registration number

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

6.2.1.4.2.2.2. Social security number

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

6.2.1.4.2.2.3. Fiscal number

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

6.2.1.4.2.2.4. Business register

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

6.2.1.4.Employer

6.2.1.5. Start date of employment

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

6.2.1.Employment and self-employment details

6.3. Additional information on the insured person's benefit details [ SED ]

6.3.1. Entitlement to sickness benefits in kind

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

6.3.2. Assistance benefit

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

6.3.3. Benefits for assistance provided by third person

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

6.4. Additional information on the spouse [ SED ]

6.4.1. Gainful employment

[ SC ]

6.4.1.1. Gainful employment

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

6.4.1.2. Amount [ SC ]

6.4.1.2.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

6.4.1.2.2. Currency

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

6.4.1.2.3. Amount effective since

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

6.4.1.2.4. Payment frequency

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

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

6.4.1.2.5.1. Other payment frequency

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

6.4.1.2.Amount

6.4.2. Fit for work

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

6.4.3. Pension recipient

[ SED ]

6.4.3.1. Pension recipient

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

6.4.3.2. Pension type

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

6.4.3.3. Pension number

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

6.4.3.4. Institution [ CC ]

6.4.3.4.1. Country *

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

6.4.3.4.2. Personal Identification Number (PIN) *

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

6.4.3.4.3. Sector

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

6.4.3.4.4. Institution

[ CC ]

6.4.3.4.4.1. Institution ID *

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

6.4.3.4.4.2. Institution Name *

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

6.4.3.5. Amount [ SC ]

6.4.3.5.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

6.4.3.5.2. Currency

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

6.4.3.5.3. Amount effective since

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

6.4.3.5.4. Payment frequency

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

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

6.4.3.5.5.1. Other payment frequency

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

6.4.3.6. Date from which the benefit was due

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

6.4.3.7. Start date of benefits payment

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

6.4.3.8. End date of benefits payment

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

6.4.3.9. Pension based on period of

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

6.4.3.Pension recipient

6.4.4. Other benefits received by the spouse

[ SC ]

6.4.4.1. Other benefits received by the spouse

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

6.4.4.2. Type of other benefits

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

6.4.4.3. Amount [ SC ]

6.4.4.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

6.4.4.3.2. Currency

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

6.4.4.3.3. Amount effective since

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

6.4.4.3.4. Payment frequency

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

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

6.4.4.3.5.1. Other payment frequency

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

6.4.4.3.Amount

6.4.5. Other resources - sources of income

[ SC ]

6.4.5.1. Other resources - sources of income

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

6.4.5.2. Type of other resources - sources of income

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

6.4.5.3. Amount [ SC ]

6.4.5.3.1. Amount

[ PRIM ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

6.4.5.3.2. Currency

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6.4.5.3.3. Amount effective since

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6.4.5.3.4. Payment frequency

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

6.4.5.3.5.1. Other payment frequency

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6.4.5.3.Amount

6.5. Additional information on the children of the insured person

[ SED ]

6.5.1. Name of the child

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6.5.2. Benefits for child

[ SC ]

6.5.2.1. Benefits for child

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6.5.2.2. Type of benefit

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6.5.2.3. Amount [ SC ]

6.5.2.3.1. Amount

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6.5.2.3.2. Currency

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6.5.2.3.3. Amount effective since

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6.5.2.3.4. Payment frequency

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

6.5.2.3.5.1. Other payment frequency

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6.5.2.3.Amount

6.5.3. Address

[ CC ]

6.5.3.1. Street

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6.5.3.2. Building Name

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6.5.3.3. Town *

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6.5.3.4. Postal Code

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6.5.3.5. Region

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6.5.3.6. Country *

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6.5.Additional information on the children of the insured person

6.6. Additional information on ascendants and other family members [ SED ]

6.6.1. Surname

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6.6.2. Forenames

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6.6.3. Birth date

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6.6.4. Relationship

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6.6.5. Address

[ CC ]

6.6.5.1. Street

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6.6.5.2. Building Name

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

6.6.5.3. Town *

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

6.6.5.4. Postal Code

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

6.6.5.5. Region

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6.6.5.6. Country *

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6.7. Unable to provide the requested information in this section

[ SC ]

6.7.1. Is the requested information available?

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6.7.2. Please fill in the following if the above is answered "No". [ SC ]

6.7.2.1. Reason

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P3000_IT - Country specific information - Italy Articles 45(4), 46(1), 47(4-5) of Regulation (EC) No 987/2009

P3000_IT - Country specific information - Italy
Articles 45(4), 46(1), 47(4-5) of Regulation (EC) No 987/2009