Request for notification

R015 - Request for notification
Article 77 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. Type of claim * [ SC ]

2.1. Type of claim *

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

2.2. Sector code *

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

2.3. Please fill in the following if "Sector code" = "Other" : [ SC ]

2.3.1. Other sector code

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

3. Concerns * [ SC ]

3.1. Concerns *

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

4. Declaration * [ SC ]

4.1. Declaration *

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

4.2. Reason for request where the claim is more than 5 years old

[ CDT ] {{metaSection.reasonForRequestWhereClaimMoreThan5YearsOld.$$error}} {{metaSection.reasonForRequestWhereClaimMoreThan5YearsOld.$$warning}}

4.3. The total amount (inclusive of interest, fines, penalties and/or costs) is: *

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

4.4. Total amount * [ CC ]

4.4.1. Amount *

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

4.4.2. Currency *

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

Please fill in the following if "Concerns" = "Person" : [ SED ]

Please fill in the following if "Concerns" = "Employer" : [ SC ]

5.1. Persons [ SC ]

5.1.1. Person * [ SC ]

5.1.1.1. Person Identification * [ CC ]

5.1.1.1.1. Family name(s) *

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

5.1.1.1.2. Forename(s) *

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

5.1.1.1.3. Date of birth *

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

5.1.1.1.4. Sex *

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

5.1.1.1.5. Family name(s) at birth

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

5.1.1.1.6. Forename(s) at birth

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

5.1.1.1.7. PIN of the person in each institution

[ CC ]

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

5.1.1.1.7.1.1. Country *

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

5.1.1.1.7.1.2. Personal Identification Number (PIN) *

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

5.1.1.1.7.1.3. Sector

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

5.1.1.1.7.1.4. Institution

[ CC ]

5.1.1.1.7.1.4.1. Institution ID *

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

5.1.1.1.7.1.4.2. Institution Name *

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

5.1.1.1.7.1.Personal Identification Number(s)

5.1.1.1.8. If PIN not provided for every institution, please provide

[ CC ]

5.1.1.1.8.1. Place of birth

[ CC ]

5.1.1.1.8.1.1. Town *

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

5.1.1.1.8.1.2. Region

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

5.1.1.1.8.1.3. Country *

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

5.1.1.1.8.2. Father's family name at birth

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

5.1.1.1.8.3. Forename of father

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

5.1.1.1.8.4. Mother's family name at birth

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

5.1.1.1.8.5. Forename of mother

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

5.1.1.2. Additional information about a person * [ SC ]

5.1.1.2.1. Status of the person *

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

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

5.1.1.2.2.1. Other status of the person

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

5.1.1.2.3. Nationality

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

5.1.1.2.4. Previous family name(s) [ SC ]

5.1.1.2.4.1. Previous family name(s) [ SC ]

5.1.1.2.4.1.1. Previous family name(s)

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

5.1.1.2.4.1.Previous family name(s)

5.1.1.2.5. Previous forenames [ SC ]

5.1.1.2.5.1. Previous forename [ SC ]

5.1.1.2.5.1.1. Previous forename

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

5.1.1.2.5.1.Previous forename

5.1.1.2.6. Current family status

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

5.1.1.2.7. Date of death

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

5.1.1.3. Person's last known addresses [ SC ]

5.1.1.3.1. Person's last known address details * [ SC ]

5.1.1.3.1.1. Type of address *

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

5.1.1.3.1.2. Please fill in the following if "Type of address" = "Other" : [ SC ]

5.1.1.3.1.2.1. Specify "Other" Type

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

5.1.1.3.1.3. Address detail *

[ CC ]

5.1.1.3.1.3.1. Street

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

5.1.1.3.1.3.2. Building Name

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

5.1.1.3.1.3.3. Town *

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

5.1.1.3.1.3.4. Postal Code

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

5.1.1.3.1.3.5. Region

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

5.1.1.3.1.3.6. Country *

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

5.1.1.3.1.Person's last known address details

5.1.1.Person

6.1. Employer *

[ CC ]

6.1.1. Name *

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

6.1.2. Identification numbers

[ CC ]

6.1.2.1. Identification number

[ CC ]

6.1.2.1.1. Number *

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

6.1.2.1.2. Type *

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

6.1.2.1.Identification number

6.1.3. Address

[ CC ]

6.1.3.1. Street

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

6.1.3.2. Building Name

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

6.1.3.3. Town *

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

6.1.3.4. Postal Code

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

6.1.3.5. Region

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

6.1.3.6. Country *

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

6.2. Responsible person or section [ SC ]

6.2.1. Responsible person or section

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

6.2.2. Contact Information [ CC ]

6.2.2.1. Telephone Numbers [ CC ]

6.2.2.1.1. Telephone Number [ CC ]

6.2.2.1.1.1. Type

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

6.2.2.1.1.2. Number *

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

6.2.2.1.1.Telephone Number

6.2.2.2. Email Addresses [ CC ]

6.2.2.2.1. Email Address [ CC ]

6.2.2.2.1.1. Email Address

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

6.2.2.2.1.Email Address

6.3. Persons

[ SC ]

6.3.1. Person * [ SC ]

6.3.1.1. Person Identification * [ CC ]

6.3.1.1.1. Family name(s) *

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

6.3.1.1.2. Forename(s) *

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

6.3.1.1.3. Date of birth *

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

6.3.1.1.4. Sex *

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

6.3.1.1.5. Family name(s) at birth

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

6.3.1.1.6. Forename(s) at birth

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

6.3.1.1.7. PIN of the person in each institution

[ CC ]

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

6.3.1.1.7.1.1. Country *

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

6.3.1.1.7.1.2. Personal Identification Number (PIN) *

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

6.3.1.1.7.1.3. Sector

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

6.3.1.1.7.1.4. Institution

[ CC ]

6.3.1.1.7.1.4.1. Institution ID *

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

6.3.1.1.7.1.4.2. Institution Name *

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

6.3.1.1.7.1.Personal Identification Number(s)

6.3.1.1.8. If PIN not provided for every institution, please provide

[ CC ]

6.3.1.1.8.1. Place of birth

[ CC ]

6.3.1.1.8.1.1. Town *

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

6.3.1.1.8.1.2. Region

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

6.3.1.1.8.1.3. Country *

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

6.3.1.1.8.2. Father's family name at birth

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

6.3.1.1.8.3. Forename of father

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

6.3.1.1.8.4. Mother's family name at birth

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

6.3.1.1.8.5. Forename of mother

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

6.3.1.2. Additional information about a person * [ SC ]

6.3.1.2.1. Status of the person *

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

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

6.3.1.2.2.1. Other status of the person

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

6.3.1.2.3. Nationality

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

6.3.1.2.4. Previous family name(s) [ SC ]

6.3.1.2.4.1. Previous family name(s) [ SC ]

6.3.1.2.4.1.1. Previous family name(s)

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

6.3.1.2.4.1.Previous family name(s)

6.3.1.2.5. Previous forenames [ SC ]

6.3.1.2.5.1. Previous forename [ SC ]

6.3.1.2.5.1.1. Previous forename

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

6.3.1.2.5.1.Previous forename

6.3.1.2.6. Current family status

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

6.3.1.2.7. Date of death

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

6.3.1.Person

7. Document to be notified * [ SED ]

7.1. Type of document to be notified *

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

7.2. Please fill in the following if Type of document = "Other" [ SED ]

7.2.1. Specify other type of document

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

8. Notification form * [ SC ]

8.1. Notification form *

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

8.2. Please fill in the following if Notification form = "Otherwise" [ SC ]

8.2.1. Specify other notification form

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

9. Timescale * [ SED ]

9.1. Notification deadline *

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

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R015 - Request for notification Article 77 of Regulation (EC) No 987/2009

R015 - Request for notification
Article 77 of Regulation (EC) No 987/2009