S100 - Inventory of months relating to reimbursement on the basis of fixed amounts (IMO)
Articles 63, 64, 65, 66, 67 of Regulation (EC) No 987/2009
SED API version: 0.14.2 PREVIEW build 3
Model version: 4.0.16
1. Global Note IMO
*
1.1. Global IMO Reference Creditor Liaison Body
*
{{metaSection.globalIMOReferenceCreditorLiaisonBody.$$error}}
{{metaSection.globalIMOReferenceCreditorLiaisonBody.$$warning}}
1.2. Total number of individual claims
*
{{metaSection.totalNumberIndividualClaims.$$error}}
{{metaSection.totalNumberIndividualClaims.$$warning}}
1.3. Total number of months
*
{{metaSection.totalNumberMonths.$$error}}
{{metaSection.totalNumberMonths.$$warning}}
1.4. Financial year
*
{{metaSection.financialYear.$$error}}
{{metaSection.financialYear.$$warning}}
1.5. Lump sum legal category
*
1.5.1. Lump sum category based on the person status
*
{{option.name}}
{{metaSection.lumpSumCategoryBasedPersonStatus.$$error}}
{{metaSection.lumpSumCategoryBasedPersonStatus.$$warning}}
1.5.2. Please fill in the following if "Lump sum legal category" = "01 - IR 987/2009, Art 63, 2.a" :
1.5.2.1. Lump sum category
{{option.name}}
{{metaSection.lumpSumCategory.$$error}}
{{metaSection.lumpSumCategory.$$warning}}
1.5.3. Please fill in the following if "Lump sum legal category" = "02 - IR 987/2009, Art 63, 2.b" :
1.5.3.1. Lump sum category
{{option.name}}
{{metaSection.lumpSumCategory.$$error}}
{{metaSection.lumpSumCategory.$$warning}}
1.6. Date of submission
*
{{metaSection.dateSubmission.$$error}}
{{metaSection.dateSubmission.$$warning}}
2. Individual IMOs
*
2.1. Individual IMO
*
2.1.1. ID Creditor Institution
*
2.1.1.1. Institution ID
*
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
2.1.1.2. Institution Name
*
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
2.1.2. ID Debtor Institution
*
2.1.2.1. Institution ID
*
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
2.1.2.2. Institution Name
*
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
2.1.3. References
*
2.1.3.1. Global IMO Reference Creditor Liaison Body
*
{{metaSection.globalIMOReferenceCreditorLiaisonBody.$$error}}
{{metaSection.globalIMOReferenceCreditorLiaisonBody.$$warning}}
2.1.3.2. Individual IMO Number Creditor Liaison Body
*
{{metaSection.individualIMONumberCreditorLiaisonBody.$$error}}
{{metaSection.individualIMONumberCreditorLiaisonBody.$$warning}}
2.1.4. Person Receiving Benefits
*
2.1.4.1. Person Information
*
2.1.4.1.1. Family name(s)
*
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
2.1.4.1.2. Forename(s)
*
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
2.1.4.1.3. Date of birth
*
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
2.1.4.1.4. Sex
*
{{option.name}}
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
2.1.4.2. Family name(s) at birth
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
2.1.4.3. Forename(s) at birth
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
2.1.4.4. Person Identification Number
*
2.1.4.4.1. PIN of the person in Competent Member State
*
{{metaSection.pINPersonInCompetentMemberState.$$error}}
{{metaSection.pINPersonInCompetentMemberState.$$warning}}
2.1.4.4.2. PIN of the person in Member State of Stay or Residence
{{metaSection.pINPersonInMemberStateStayOrResidence.$$error}}
{{metaSection.pINPersonInMemberStateStayOrResidence.$$warning}}
2.1.5. Entitlement document
*
{{option.name}}
{{metaSection.entitlementDocument.$$error}}
{{metaSection.entitlementDocument.$$warning}}
2.1.6. Validity period
*
Fixed period
*
Open period
*
2.1.6.1.1. Start date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
2.1.6.1.2. End date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
2.1.6.2.1. Type of Open Period
*
{{option.name}}
{{metaSection.typeOpenPeriod.$$error}}
{{metaSection.typeOpenPeriod.$$warning}}
2.1.6.2.2. Start date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
2.1.7. Accounting period
*
2.1.7.1. Start Date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
2.1.7.2. End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
2.1.8. Number of months
*
{{metaSection.numberMonths.$$error}}
{{metaSection.numberMonths.$$warning}}
2.1.9. Date of issue IMO of institution in place of residence
*
{{metaSection.dateIssueIMOInstitutionInPlaceResidence.$$error}}
{{metaSection.dateIssueIMOInstitutionInPlaceResidence.$$warning}}
2.1.Individual IMO
{{locale['Add']}}
×