Reimbursement Payment Notification

U024 - Reimbursement Payment Notification
Articles 65(6), 65(7) of Regulation (EC) No 883/2004, Article 70 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. General information * [ SED ]

2.1. Reimbursement request ID *

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

2.2. Reimbursement payment notification ID *

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

3. Amount reimbursed * [ SED ]

3.1. Amount * [ CC ]

3.1.1. Amount *

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3.1.2. Currency *

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3.2. Date of payment *

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

4. Bank information * [ SC ]

4.1. SEPA Bank Details * [ CC ]

4.1.1. IBAN *

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4.1.2. BIC-SWIFT

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4.2. Bank transfer: subject or transaction reference *

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5. Individual claims to which the payment relates * [ SED ]

5.1. Individual claim to which the payment relates * [ SED ]

5.1.1. Reimbursement request ID *

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5.1.2. Reimbursement Payment Notification ID *

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

5.1.3. Sequential number of Individual claim *

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5.1.4. Contested individual claim ID

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5.1.5. Amended contested individual claim ID

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

5.1.6. Individual claim Payment Notification ID *

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

5.1.7. Person * [ CC ]

5.1.7.1. Family name(s) *

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

5.1.7.2. Forename(s) *

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

5.1.7.3. Date of birth *

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5.1.7.4. Sex *

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5.1.Individual claim to which the payment relates

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U024 - Reimbursement Payment Notification Articles 65(6), 65(7) of Regulation (EC) No 883/2004, Article 70 of Regulation (EC) No 987/2009

U024 - Reimbursement Payment Notification
Articles 65(6), 65(7) of Regulation (EC) No 883/2004, Article 70 of Regulation (EC) No 987/2009