R017 - Request for recovery/precautionary measures
Articles 75, 78, 79, 80, 81(2), 82, 83, 84 or 90 of Regulation (EC) No 987/2009
SED API version: 0.15.2 build 3
Model version: 4.1.0
1. Local case numbers
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1.1. Local Case Number
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1.1.1. Country
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1.1.2. Case number
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1.1.3. Institution
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1.1.3.1. Institution ID
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1.1.3.2. Institution Name
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2. Type of request
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2.1. Type of request
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3. Declaration
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3.1. Declaration
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3.1.1. Claim and or instrument permitting enforcement is:
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3.1.2. Appropriate recovery procedures already taken by applicant party will not lead to payment in full of the claim and period of limitation under legislation in force in Member State of the applicant party has not expired
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3.1.3. Claim is under 5 years old (Art82(1)(b) of Regulation (EC) 987/2009)
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3.1.4. Please fill in the following if "Claim is under 5 years old (Art82(1)(b) of Regulation 987/2009)" = "No" :
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3.1.4.1. Reason for request where the claim is more than 5 years old
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3.2. The total amount (inclusive of interest, fines, penalties and/or costs) is:
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4. Type of claim
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4.1. Type of claim
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4.2. Sector code
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4.3. Please fill in the following if "Sector code" = "Other" :
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4.3.1. Other sector code
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5. Concerns
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5.1. Concerns
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Please fill in the following if "Concerns" = "Person" :
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Please fill in the following if "Concerns" = "Employer" :
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6.1. Persons
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6.1.1. Person
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6.1.1.1. Person Identification
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6.1.1.1.1. Family name(s)
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6.1.1.1.2. Forename(s)
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6.1.1.1.3. Date of birth
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6.1.1.1.4. Sex
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6.1.1.1.5. Family name(s) at birth
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6.1.1.1.6. Forename(s) at birth
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6.1.1.1.7. PIN of the person in each institution
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6.1.1.1.7.1. Personal Identification Number(s)
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6.1.1.1.7.1.1. Country
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6.1.1.1.7.1.2. Personal Identification Number (PIN)
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6.1.1.1.7.1.3. Sector
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6.1.1.1.7.1.4. Institution
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6.1.1.1.7.1.4.1. Institution ID
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6.1.1.1.7.1.4.2. Institution Name
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6.1.1.1.8. If PIN not provided for every institution, please provide
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6.1.1.1.8.1. Place of birth
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6.1.1.1.8.1.1. Town
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6.1.1.1.8.1.2. Region
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6.1.1.1.8.1.3. Country
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6.1.1.1.8.2. Father's family name at birth
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6.1.1.1.8.3. Forename of father
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6.1.1.1.8.4. Mother's family name at birth
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6.1.1.1.8.5. Forename of mother
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6.1.1.2. Additional information about a person
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6.1.1.2.1. Status of the person
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6.1.1.2.2. Please fill in the following if "Status of the person" = "Other" :
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6.1.1.2.2.1. Other status of the person
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6.1.1.2.3. Nationality
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6.1.1.2.4. Previous family name(s)
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6.1.1.2.4.1. Previous family name(s)
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6.1.1.2.4.1.1. Previous family name(s)
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6.1.1.2.5. Previous forenames
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6.1.1.2.5.1. Previous forename
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6.1.1.2.5.1.1. Previous forename
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6.1.1.2.6. Current family status
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6.1.1.2.7. Date of death
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6.1.1.3. Person's last known addresses
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6.1.1.3.1. Person's last known address details
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6.1.1.3.1.1. Type of address
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6.1.1.3.1.2. Please fill in the following if "Type of address" = "Other" :
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6.1.1.3.1.2.1. Specify "Other" Type
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6.1.1.3.1.3. Address detail
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6.1.1.3.1.3.1. Street
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6.1.1.3.1.3.2. Building Name
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6.1.1.3.1.3.3. Town
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6.1.1.3.1.3.4. Postal Code
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6.1.1.3.1.3.5. Region
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6.1.1.3.1.3.6. Country
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7.1. Employer
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7.1.1. Name
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7.1.2. Identification numbers
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7.1.2.1. Identification number
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7.1.2.1.1. Number
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7.1.2.1.2. Type
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7.1.3. Address
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7.1.3.1. Street
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7.1.3.2. Building Name
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7.1.3.3. Town
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7.1.3.4. Postal Code
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7.1.3.5. Region
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7.1.3.6. Country
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7.2. Responsible person or section
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7.2.1. Responsible person or section
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7.2.2. Contact Information
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7.2.2.1. Telephone Numbers
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7.2.2.1.1. Telephone Number
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7.2.2.1.1.1. Type
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7.2.2.1.1.2. Number
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7.2.2.2. Email Addresses
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7.2.2.2.1. Email Address
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7.2.2.2.1.1. Email Address
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7.3. Persons
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7.3.1. Person
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7.3.1.1. Person Identification
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7.3.1.1.1. Family name(s)
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7.3.1.1.2. Forename(s)
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7.3.1.1.3. Date of birth
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7.3.1.1.4. Sex
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7.3.1.1.5. Family name(s) at birth
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7.3.1.1.6. Forename(s) at birth
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7.3.1.1.7. PIN of the person in each institution
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7.3.1.1.7.1. Personal Identification Number(s)
*
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7.3.1.1.7.1.1. Country
*
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7.3.1.1.7.1.2. Personal Identification Number (PIN)
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7.3.1.1.7.1.3. Sector
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7.3.1.1.7.1.4. Institution
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7.3.1.1.7.1.4.1. Institution ID
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7.3.1.1.7.1.4.2. Institution Name
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7.3.1.1.8. If PIN not provided for every institution, please provide
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7.3.1.1.8.1. Place of birth
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7.3.1.1.8.1.1. Town
*
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7.3.1.1.8.1.2. Region
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7.3.1.1.8.1.3. Country
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7.3.1.1.8.2. Father's family name at birth
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7.3.1.1.8.3. Forename of father
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7.3.1.1.8.4. Mother's family name at birth
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7.3.1.1.8.5. Forename of mother
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7.3.1.2. Additional information about a person
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7.3.1.2.1. Status of the person
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7.3.1.2.2. Please fill in the following if "Status of the person" = "Other" :
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7.3.1.2.2.1. Other status of the person
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7.3.1.2.3. Nationality
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7.3.1.2.4. Previous family name(s)
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7.3.1.2.4.1. Previous family name(s)
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7.3.1.2.4.1.1. Previous family name(s)
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7.3.1.2.5. Previous forenames
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7.3.1.2.5.1. Previous forename
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7.3.1.2.5.1.1. Previous forename
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7.3.1.2.6. Current family status
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7.3.1.2.7. Date of death
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8. Third parties holding assets of the debtor
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8.1. Third party holding assets of the debtor
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8.1.1. Third party
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8.1.1.1. Third party name
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8.1.1.2. Third party address
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8.1.1.2.1. Street
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8.1.1.2.2. Building Name
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8.1.1.2.3. Town
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8.1.1.2.4. Postal Code
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8.1.1.2.5. Region
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8.1.1.2.6. Country
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8.1.2. Assets held by third party
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9. The Claim
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9.1. Claim details
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9.1.1. Claim information
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9.1.1.1. Currency
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9.1.1.1.1. Currency of the Sending Institution
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9.1.1.1.2. Currency of the Receiving Institution
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9.1.1.2. Exchange rates used on date of request
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9.1.1.2.1. Exchange rate used on date of request
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9.1.1.2.1.1. Exchange rate
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9.1.1.3. Period
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9.1.1.3.1. Start Date
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9.1.1.3.2. End Date
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9.1.1.4. Amount in the currency of the sending institution
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9.1.1.4.1. Principal amount
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9.1.1.4.2. Interest
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9.1.1.4.3. Fines
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9.1.1.4.4. Administrative penalties
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9.1.1.4.5. Other charges or costs
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9.1.1.4.6. Total amount
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9.1.1.5. Amount In The Currency Of The Receiving Institution
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9.1.1.5.1. Principal amount
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9.1.1.5.2. Interest
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9.1.1.5.3. Fines
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9.1.1.5.4. Administrative penalties
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9.1.1.5.5. Other charges or costs
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9.1.1.5.6. Total amount
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9.1.2. Identification of the claim
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9.1.2.1. Date of Instrument Permitting Enforcement
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9.1.2.2. Date of notification
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9.1.2.3. Date on which enforcement becomes possible
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9.1.2.4. Last day of period of limitation
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9.1.2.5. Reference to identify the instrument permitting enforcement
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10. Overall amount
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10.1. This request concerns
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10.2. Please fill in the following if "This request concerns" = "more than one claim and total amount" :
[ SED ]
10.2.1. The combined total amount of the claims in the currency of the sending institution
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10.2.2. The combined total amount of the claims in the currency of the receiving institution
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11. Additional information
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11.1. Additional information
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12. Please fill in the following if "Type of request" = "Recovery"
[ SED ]
12.1. Agreement to accept payment by instalment
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12.1.1. Payment by instalment is
*
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12.2. Bank details
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12.2.1. SEPA Bank details
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12.2.1.1. IBAN
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12.2.1.2. BIC-SWIFT
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12.2.2. Account holder name
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12.2.3. Payment reference
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12.2.4. Receiving bank address
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12.2.4.1. Street
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12.2.4.2. Building Name
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12.2.4.3. Town
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12.2.4.4. Postal Code
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12.2.4.5. Region
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12.2.4.6. Country
*
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