Information on Change of Entitlement to Benefits in Kind

S005 - Information on Change of Entitlement to Benefits in Kind - Long term care
Article 34 of Regulation (EC) No 883/2004; Article 31 of Regulation (EC) No 978/2009

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Person * [ SC ]

1.1. Person Identification * [ CC ]

1.1.1. Family name(s) *

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1.1.2. Forename(s) *

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1.1.3. Date of birth *

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1.1.4. Sex *

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1.1.5. Family name(s) at birth

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1.1.6. Forename(s) at birth

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

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

1.1.7.1.1. Country *

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1.1.7.1.2. Personal Identification Number (PIN) *

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1.1.7.1.3. Sector

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1.1.7.1.4. Institution [ CC ]

1.1.7.1.4.1. Institution ID *

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1.1.7.1.4.2. Institution Name *

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1.1.7.1.Personal Identification Number(s)

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

1.1.8.1. Place of birth [ CC ]

1.1.8.1.1. Town *

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1.1.8.1.2. Region

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1.1.8.1.3. Country *

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1.1.8.2. Father's family name at birth

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1.1.8.3. Forename of father

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1.1.8.4. Mother's family name at birth

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1.1.8.5. Forename of mother

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1.2. Additional information on the person [ SC ]

1.2.1. Nationality

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2. Person's address [ SC ]

2.1. Address * [ CC ]

2.1.1. Street

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2.1.2. Building Name

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2.1.3. Town *

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2.1.4. Postal Code

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2.1.5. Region

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2.1.6. Country *

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2.2. Residence in this country since

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3. Change of entitlement to benefits in kind _ long term care * [ SC ]

3.1. Period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

3.1.1.1. Start date *

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3.1.1.2. End date *

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3.1.2.1. Type of Open Period *

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3.1.2.2. Start date *

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3.2. Amount * [ CC ]

3.2.1. Amount *

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3.2.2. Currency *

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3.3. Frequency of payment *

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3.4. Please fill in the following if "Frequency of payment" = "99 - Other" : [ SC ]

3.4.1. Other

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3.4.2. Description of the benefits

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S005 - Information on Change of Entitlement to Benefits in Kind - Long term care Article 34 of Regulation (EC) No 883/2004; Article 31 of Regulation (EC) No 978/2009

S005 - Information on Change of Entitlement to Benefits in Kind - Long term care
Article 34 of Regulation (EC) No 883/2004; Article 31 of Regulation (EC) No 978/2009