F005 - Reply to clarifications
Articles 67, 68 of Regulation (EC) No 883/2004, Articles 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(4)of Regulation (EC) No 987/2009
SED API version: 0.16.2 build 2
Model version: 4.2.0
Reply to requested clarification on the grounds for our decision concerning
Type of decision
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Date of your decision
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Grounds of Disagreement
Employment/self-employment period/status
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Period of pension received
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Insurance period
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Duration on territory
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Residence of child(ren)
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Personal situation elements (article 11 of Regulation (EC) No 987/2009)
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Additional grounds for disagreement
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Claimant
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Person Identification
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Family name(s)
*
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Forename(s)
*
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Date of birth
*
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Sex
*
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Family name(s) at birth
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Forename(s) at birth
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PIN of the person in each institution
Personal Identification Number(s)
*
Country
*
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Personal Identification Number (PIN)
*
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Sector
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Institution
Institution ID
*
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Institution Name
*
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If PIN not provided for every institution, please provide
Place of birth
Town
*
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Region
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Country
*
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Father's family name at birth
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Forename of father
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Mother's family name at birth
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Forename of mother
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Additional information about nationality
Nationalities
Nationality
*
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Since
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Addresses of the person
Address of the Person
Type of address
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Address
Street
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Building Name
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Town
*
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Postal Code
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Region
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Country
*
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Contact Details
Telephone Numbers
Telephone Number
Type
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Number
*
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Email Addresses
Email Address
Email Address
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Coverage by social security scheme
Periods Covered by security scheme in sending Member State
Period
Start Date
*
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End Date
*
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Periods Not covered
Period Not Covered
Start Date
*
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End Date
*
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Periods of Entitlement
Entitlement to Family Benefits, if yes
If no entitlement, choose one reason
Period Entitlement Family Benefits
Period of Entitlement to family benefit
Start Date
*
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End Date
*
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Reason
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Other reason
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Information on spouse or partner
Person Identification
*
Family name(s)
*
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Forename(s)
*
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Date of birth
*
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Sex
*
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Family name(s) at birth
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Forename(s) at birth
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PIN of the person in each institution
Personal Identification Number(s)
*
Country
*
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Personal Identification Number (PIN)
*
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Sector
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Institution
Institution ID
*
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Institution Name
*
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If PIN not provided for every institution, please provide
Place of birth
Town
*
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Region
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Country
*
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Father's family name at birth
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Forename of father
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Mother's family name at birth
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Forename of mother
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Additional information about nationality
Nationalities
Nationality
*
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Since
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Addresses of the person
Address of the Person
Type of address
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Address
Street
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Building Name
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Town
*
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Postal Code
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Region
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Country
*
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Contact Details
Telephone Numbers
Telephone Number
Type
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Number
*
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Email Addresses
Email Address
Email Address
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Coverage by social security scheme
Periods Covered by security scheme in sending Member State
Period
Start Date
*
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End Date
*
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Periods Not covered
Period Not Covered
Start Date
*
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End Date
*
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Periods of Entitlement
Entitlement to Family Benefits, if yes
If no entitlement, choose one reason
Period Entitlement Family Benefits
Period of Entitlement to family benefit
Start Date
*
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End Date
*
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Reason
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Other reason
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Information on other person
Person Identification
*
Family name(s)
*
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Forename(s)
*
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Date of birth
*
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Sex
*
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Family name(s) at birth
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Forename(s) at birth
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PIN of the person in each institution
Personal Identification Number(s)
*
Country
*
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Personal Identification Number (PIN)
*
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Sector
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Institution
Institution ID
*
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Institution Name
*
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If PIN not provided for every institution, please provide
Place of birth
Town
*
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Region
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Country
*
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Father's family name at birth
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Forename of father
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Mother's family name at birth
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Forename of mother
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Additional information about nationality
Nationalities
Nationality
*
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Since
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Addresses of the person
Address of the Person
Type of address
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Address
Street
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Building Name
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Town
*
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Postal Code
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Region
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Country
*
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Contact Details
Telephone Numbers
Telephone Number
Type
{{option.name}}
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Number
*
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Email Addresses
Email Address
Email Address
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{{metaSection.email.$$warning}}
Coverage by social security scheme
Periods Covered by security scheme in sending Member State
Period
Start Date
*
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End Date
*
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Periods Not covered
Period Not Covered
Start Date
*
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End Date
*
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{{metaSection.endDate.$$warning}}
Periods of Entitlement
Entitlement to Family Benefits, if yes
If no entitlement, choose one reason
Period Entitlement Family Benefits
Period of Entitlement to family benefit
Start Date
*
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End Date
*
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Reason
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Other reason
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Claiming authority
Reason for authority claim
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Claiming authority
Institution ID
*
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Institution Name
*
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Bank details
SEPA account
*
Non-SEPA account
*
IBAN
*
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BIC-SWIFT
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Account number
*
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BIC-SWIFT
*
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Bank Name
*
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Bank Address
*
Street
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Building Name
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Town
*
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Postal Code
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Region
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Country
*
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Information on child(ren)
*
Child
*
Child Details
*
Family name(s)
*
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Forename(s)
*
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Date of birth
*
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Sex
*
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Family name(s) at birth
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Forename(s) at birth
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PIN of the person in each institution
Personal Identification Number(s)
*
Country
*
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Personal Identification Number (PIN)
*
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Sector
{{$select.selected[ 'name']}}
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Institution
Institution ID
*
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{{metaSection.institutionID.$$warning}}
Institution Name
*
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{{metaSection.institutionName.$$warning}}
If PIN not provided for every institution, please provide
Place of birth
Town
*
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Region
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{{metaSection.region.$$warning}}
Country
*
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Father's family name at birth
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Forename of father
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Mother's family name at birth
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{{metaSection.motherFamilyNameAtBirth.$$warning}}
Forename of mother
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Additional information about nationality
Nationalities
Nationality
*
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Since
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Addresses of the child
Address of the Person
Type of address
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{{metaSection.typeAddress.$$warning}}
Address
Street
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{{metaSection.street.$$warning}}
Building Name
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Town
*
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Postal Code
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Region
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Country
*
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