Decision on contestation

R034 - Decision on contestation
Article 81 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 *

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1.1.2. Case number *

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1.1.3. Institution [ CC ]

1.1.3.1. Institution ID *

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1.1.3.2. Institution Name *

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

1.1.Local Case Number

2. Concerns * [ SC ]

2.1. Concerns *

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

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

3.1. Persons [ SC ]

3.1.1. Person * [ SC ]

3.1.1.1. Person Identification * [ CC ]

3.1.1.1.1. Family name(s) *

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3.1.1.1.2. Forename(s) *

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3.1.1.1.3. Date of birth *

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3.1.1.1.4. Sex *

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3.1.1.1.5. Family name(s) at birth

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3.1.1.1.6. Forename(s) at birth

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

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

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

3.1.1.1.7.1.1. Country *

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3.1.1.1.7.1.2. Personal Identification Number (PIN) *

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3.1.1.1.7.1.3. Sector

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3.1.1.1.7.1.4. Institution [ CC ]

3.1.1.1.7.1.4.1. Institution ID *

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3.1.1.1.7.1.4.2. Institution Name *

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3.1.1.1.7.1.Personal Identification Number(s)

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

3.1.1.1.8.1. Place of birth [ CC ]

3.1.1.1.8.1.1. Town *

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3.1.1.1.8.1.2. Region

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

3.1.1.1.8.1.3. Country *

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3.1.1.1.8.2. Father's family name at birth

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3.1.1.1.8.3. Forename of father

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

3.1.1.1.8.4. Mother's family name at birth

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

3.1.1.1.8.5. Forename of mother

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

3.1.1.2. Additional information about a person * [ SC ]

3.1.1.2.1. Status of the person *

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

3.1.1.2.2.1. Other status of the person

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3.1.1.2.3. Nationality

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3.1.1.2.4. Previous family name(s) [ SC ]

3.1.1.2.4.1. Previous family name(s) [ SC ]

3.1.1.2.4.1.1. Previous family name(s)

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

3.1.1.2.4.1.Previous family name(s)

3.1.1.2.5. Previous forenames [ SC ]

3.1.1.2.5.1. Previous forename [ SC ]

3.1.1.2.5.1.1. Previous forename

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3.1.1.2.5.1.Previous forename

3.1.1.2.6. Current family status

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3.1.1.2.7. Date of death

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

3.1.1.Person

4.1. Employer * [ CC ]

4.1.1. Name *

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

4.1.2. Identification numbers [ CC ]

4.1.2.1. Identification number [ CC ]

4.1.2.1.1. Number *

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

4.1.2.1.2. Type *

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

4.1.2.1.Identification number

4.1.3. Address [ CC ]

4.1.3.1. Street

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4.1.3.2. Building Name

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

4.1.3.3. Town *

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4.1.3.4. Postal Code

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4.1.3.5. Region

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4.1.3.6. Country *

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4.2. Responsible person or section [ SC ]

4.2.1. Responsible person or section

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4.2.2. Contact Information [ CC ]

4.2.2.1. Telephone Numbers [ CC ]

4.2.2.1.1. Telephone Number [ CC ]

4.2.2.1.1.1. Type

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4.2.2.1.1.2. Number *

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

4.2.2.1.1.Telephone Number

4.2.2.2. Email Addresses [ CC ]

4.2.2.2.1. Email Address [ CC ]

4.2.2.2.1.1. Email Address

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4.2.2.2.1.Email Address

4.3. Persons [ SC ]

4.3.1. Person * [ SC ]

4.3.1.1. Person Identification * [ CC ]

4.3.1.1.1. Family name(s) *

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

4.3.1.1.2. Forename(s) *

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

4.3.1.1.3. Date of birth *

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

4.3.1.1.4. Sex *

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4.3.1.1.5. Family name(s) at birth

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4.3.1.1.6. Forename(s) at birth

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

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

4.3.1.1.7.1.1. Country *

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4.3.1.1.7.1.2. Personal Identification Number (PIN) *

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

4.3.1.1.7.1.3. Sector

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4.3.1.1.7.1.4. Institution [ CC ]

4.3.1.1.7.1.4.1. Institution ID *

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

4.3.1.1.7.1.4.2. Institution Name *

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

4.3.1.1.7.1.Personal Identification Number(s)

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

4.3.1.1.8.1. Place of birth [ CC ]

4.3.1.1.8.1.1. Town *

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4.3.1.1.8.1.2. Region

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

4.3.1.1.8.1.3. Country *

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4.3.1.1.8.2. Father's family name at birth

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4.3.1.1.8.3. Forename of father

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4.3.1.1.8.4. Mother's family name at birth

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4.3.1.1.8.5. Forename of mother

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

4.3.1.2. Additional information about a person * [ SC ]

4.3.1.2.1. Status of the person *

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

4.3.1.2.2.1. Other status of the person

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4.3.1.2.3. Nationality

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4.3.1.2.4. Previous family name(s) [ SC ]

4.3.1.2.4.1. Previous family name(s) [ SC ]

4.3.1.2.4.1.1. Previous family name(s)

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

4.3.1.2.4.1.Previous family name(s)

4.3.1.2.5. Previous forenames [ SC ]

4.3.1.2.5.1. Previous forename [ SC ]

4.3.1.2.5.1.1. Previous forename

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

4.3.1.2.5.1.Previous forename

4.3.1.2.6. Current family status

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4.3.1.2.7. Date of death

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

4.3.1.Person

5. Result of contestation * [ SED ]

5.1. The decision of the appropriate authority was found in favour *

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5.2. Please fill in the following if "The decision of the appropriate authority was found in favour" = "Other" : [ SED ]

5.2.1. Give details

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5.3. Date of decision *

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6. Impact of decision * [ SED ]

6.1. Action to take *

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6.2. Please fill in the following if "Action to take" = "Other" : [ SED ]

6.2.1. Give details

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7. Revised claim [ SED ]

7.1. Claim details * [ SC ]

7.1.1. Currency [ SC ]

7.1.1.1. Currency of the Sending Institution *

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7.1.1.2. Currency of the Receiving Institution *

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7.1.2. Exchange rates used on date of request * [ SC ]

7.1.2.1. Exchange rate used on date of request * [ SC ]

7.1.2.1.1. Exchange rate *

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7.1.2.1.Exchange rate used on date of request

7.1.3. Period [ CC ]

7.1.3.1. Start Date *

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7.1.3.2. End Date *

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7.1.4. Amount in the currency of the sending institution * [ SC ]

7.1.4.1. Principal amount

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7.1.4.2. Interest

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7.1.4.3. Fines

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7.1.4.4. Administrative penalties

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7.1.4.5. Other charges or costs

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7.1.4.6. Total amount *

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7.1.5. Amount In The Currency Of The Receiving Institution * [ SC ]

7.1.5.1. Principal amount

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7.1.5.2. Interest

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7.1.5.3. Fines

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7.1.5.4. Administrative penalties

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7.1.5.5. Other charges or costs

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7.1.5.6. Total amount *

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7.1.Claim details

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R034 - Decision on contestation Article 81 of Regulation (EC) No 987/2009

R034 - Decision on contestation
Article 81 of Regulation (EC) No 987/2009