S055 - Application for Cash Benefits
Article 21 of Regulation (EC) No 883/2004; Articles 27(3),(8),(10) of Regulation (EC) No 987/2009
SED API version: 0.14.2 PREVIEW build 3
Model version: 4.0.16
1. Person
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1.1. Person Identification
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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
1.1.7.1. Personal Identification Number(s)
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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
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)
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1.1.8. If PIN not provided for every institution, please provide
1.1.8.1. Place of birth
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
1.2.1. Nationality
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2. Person's address
2.1. Street
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2.2. Building Name
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2.3. Town
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2.4. Postal Code
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2.5. Region
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2.6. Country
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3. Certificate of incapacity of work
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3.1. The person mentioned above applied for cash benefits on
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3.2. Type of benefit
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3.3. Please find attached
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3.4. Please fill in the following if "Please find attached" = "Other document" :
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3.4.1. Other document
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3.5. According to the document mentioned above the person is incapable for work
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Fixed period
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Open period
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3.5.1.1. Start date
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3.5.1.2. End date
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3.5.2.1. Type of Open Period
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3.5.2.2. Start date
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3.6. Child birth
3.6.1. Expected date of delivery
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3.6.2. Date of child birth
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4. Employer
4.1. Name
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4.2. Identification numbers
4.2.1. Identification number
4.2.1.1. Number
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4.2.1.2. Type
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4.2.1.Identification number
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4.3. Address
4.3.1. Street
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4.3.2. Building Name
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4.3.3. Town
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4.3.4. Postal Code
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4.3.5. Region
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4.3.6. Country
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5. Additional information
5.1. Additional information
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