Information of registration

S073 - Information of registration - residence
Articles 17, 22, 24, 25, 26 of Regulation (EC) No 883/2004; Article 24 of Regulation (EC) No 987/2009

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) *

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

1.1.2. Forename(s) *

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

1.1.3. Date of birth *

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

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 *

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

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

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

1.1.8.1.3. Country *

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

1.1.8.2. Father's family name at birth

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

1.1.8.3. Forename of father

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

1.1.8.4. Mother's family name at birth

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

1.1.8.5. Forename of mother

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

1.2. Additional information on the person [ SC ]

1.2.1. Nationality

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

2. Address (of the person for whom information on registration is sent) * [ SC ]

2.1. Address * [ CC ]

2.1.1. Street

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2.1.2. Building Name

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

2.1.3. Town *

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

2.1.4. Postal Code

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

2.1.5. Region

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

2.1.6. Country *

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2.2. Residence in this country since

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3. Status * [ SC ]

3.1. status *

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4. Please fill in the following if "Status of the person" = "Family member of insured person" or "Status of the person" = "Family member of pensioner" : [ SED ]

4.1. Insured Person

[ SC ]

4.1.1. Person Identification * [ CC ]

4.1.1.1. Family name(s) *

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

4.1.1.2. Forename(s) *

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

4.1.1.3. Date of birth *

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

4.1.1.4. Sex *

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

4.1.1.5. Family name(s) at birth

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

4.1.1.6. Forename(s) at birth

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

4.1.1.7. PIN of the person in each institution

[ CC ]

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

4.1.1.7.1.1. Country *

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

4.1.1.7.1.2. Personal Identification Number (PIN) *

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

4.1.1.7.1.3. Sector

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

4.1.1.7.1.4. Institution

[ CC ]

4.1.1.7.1.4.1. Institution ID *

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

4.1.1.7.1.4.2. Institution Name *

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

4.1.1.7.1.Personal Identification Number(s)

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

[ CC ]

4.1.1.8.1. Place of birth

[ CC ]

4.1.1.8.1.1. Town *

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

4.1.1.8.1.2. Region

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

4.1.1.8.1.3. Country *

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

4.1.1.8.2. Father's family name at birth

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

4.1.1.8.3. Forename of father

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

4.1.1.8.4. Mother's family name at birth

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

4.1.1.8.5. Forename of mother

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

4.1.2. Additional information on the person [ SC ]

4.1.2.1. Nationality

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

4.2. Address of the main insured person

[ CC ]

4.2.1. Street

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

4.2.2. Building Name

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

4.2.3. Town *

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

4.2.4. Postal Code

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

4.2.5. Region

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

4.2.6. Country *

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

5. Concerns your document * [ SED ]

5.1. Type of document *

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5.2. Issued on *

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6. Entitlement * [ SED ]

6.1. Entitlement document *

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6.2. Issued on *

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

7. Information on registration * [ SED ]

7.1. Information on registration *

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

7.2. Period of registration [ SED ]

7.2.1. Registration period [ CC ]

Fixed period* [ CC ]

Open period* [ CC ]

7.2.1.1.1. Start date *

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7.2.1.1.2. End date *

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7.2.1.2.1. Type of Open Period *

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7.2.1.2.2. Start date *

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7.3. Reason for refusal of registration [ SED ]

7.3.1. Reason

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Please fill in the following if "Reason" = "01 - Insured as employed or self-employed person in member state of residence since" or "Reason = "02 - Insured as pensioner in member state of residence since" or "Reason = "05 - Has moved from this member state on" or "Reason = "06 - Died on" : [ SED ]

Please fill in the following if "Reason" = "99 - Other reason" : [ SC ]

7.3.2.1. Date

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7.3.3.1. Other reason

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S073 - Information of registration - residence Articles 17, 22, 24, 25, 26 of Regulation (EC) No 883/2004; Article 24 of Regulation (EC) No 987/2009

S073 - Information of registration - residence
Articles 17, 22, 24, 25, 26 of Regulation (EC) No 883/2004; Article 24 of Regulation (EC) No 987/2009