S041 - Reply to Request for Periods - Insurance Risk Type: Sickness, Maternity or Paternity
Article 6 of Regulation (EC) No 883/2004; Article 12(1) of Regulation (EC) No 987/2009
SED API version: 0.14.2 PREVIEW build 3
Model version: 4.0.16
1. Person
*
1.1. Person Identification
*
1.1.1. Family name(s)
*
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
1.1.2. Forename(s)
*
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
1.1.3. Date of birth
*
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
1.1.4. Sex
*
{{option.name}}
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
1.1.5. Family name(s) at birth
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
1.1.6. Forename(s) at birth
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
1.1.7. PIN of the person in each institution
1.1.7.1. Personal Identification Number(s)
*
1.1.7.1.1. Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
1.1.7.1.2. Personal Identification Number (PIN)
*
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
1.1.7.1.3. Sector
{{$select.selected[ 'name']}}
{{metaSection.sector.$$error}}
{{metaSection.sector.$$warning}}
1.1.7.1.4. Institution
1.1.7.1.4.1. Institution ID
*
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
1.1.7.1.4.2. Institution Name
*
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
1.1.7.1.Personal Identification Number(s)
{{locale['Add']}}
×
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
*
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
1.1.8.1.2. Region
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
1.1.8.1.3. Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
1.1.8.2. Father's family name at birth
{{metaSection.fatherFamilyNameAtBirth.$$error}}
{{metaSection.fatherFamilyNameAtBirth.$$warning}}
1.1.8.3. Forename of father
{{metaSection.forenameFather.$$error}}
{{metaSection.forenameFather.$$warning}}
1.1.8.4. Mother's family name at birth
{{metaSection.motherFamilyNameAtBirth.$$error}}
{{metaSection.motherFamilyNameAtBirth.$$warning}}
1.1.8.5. Forename of mother
{{metaSection.forenameMother.$$error}}
{{metaSection.forenameMother.$$warning}}
1.2. Additional information on the person
1.2.1. Nationality
{{metaSection.nationality.$$error}}
{{metaSection.nationality.$$warning}}
2. Person's address
2.1. Address
*
2.1.1. Street
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
2.1.2. Building Name
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
2.1.3. Town
*
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
2.1.4. Postal Code
{{metaSection.postalCode.$$error}}
{{metaSection.postalCode.$$warning}}
2.1.5. Region
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
2.1.6. Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
2.2. Residence in this country since
{{metaSection.residenceInThisCountrySince.$$error}}
{{metaSection.residenceInThisCountrySince.$$warning}}
3. Reply
*
3.1. In reply to your S040 ...
*
{{option.name}}
{{metaSection.inReplyS040.$$error}}
{{metaSection.inReplyS040.$$warning}}
4. Reply to request for periods
4.1. Insurance periods
4.1.1. Insurance period
4.1.1.1. Period
Fixed period
*
Open period
*
4.1.1.1.1.1. Start date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
4.1.1.1.1.2. End date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
4.1.1.1.2.1. Type of Open Period
*
{{option.name}}
{{metaSection.typeOpenPeriod.$$error}}
{{metaSection.typeOpenPeriod.$$warning}}
4.1.1.1.2.2. Start date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
4.1.1.2. Insurance type
*
{{option.name}}
{{metaSection.insurance.$$error}}
{{metaSection.insurance.$$warning}}
4.1.1.Insurance period
{{locale['Add']}}
×
4.2. Employment periods
4.2.1. Employment period
4.2.1.1. Start date
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
4.2.1.2. End date
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
4.2.1.Employment period
{{locale['Add']}}
×
4.3. Self employment periods
4.3.1. Self employment period
4.3.1.1. Start date
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
4.3.1.2. End date
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
4.3.1.Self employment period
{{locale['Add']}}
×
4.4. Residence periods
4.4.1. Residence period
4.4.1.1. Start date
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
4.4.1.2. End date
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
4.4.1.Residence period
{{locale['Add']}}
×
5. Additional information
5.1. Additional information
{{metaSection.additionalInformation.$$error}}
{{metaSection.additionalInformation.$$warning}}