Request for determining competence

F001 - Request for determining competence
Articles 1(i), 11, 67, 68 of Regulation (EC) No 883/2004; Articles 2(2), 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(5), 72, 73, 74 of Regulation (EC) No 987/2009

SED API version: 0.16.2 build 2
Model version: 4.2.0

Purpose of this SED

Receipt of application for family benefits

Date of receipt of the application

Request for period of information

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Request for period of information

Type of claim

Information on application

Points for which more information is needed

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Information about change in circumstances

Change of Circumstance for

Additional request or information

Additional information

Decision

Decision regarding all children mentioned in this SED
Decision which does not concern all children mentioned in this SED

Decision regarding all children mentioned in this SED

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Decision regarding all children mentioned in this SED

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Child for whom this decision applies

Family Name *

Forename *

Date of Birth *

Child for whom this decision applies

Periods

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Type of decision

The reason for decision

Additional information

Decisions on primary competence with article 68 of Regulation (EC) No 883/2004

Decision

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Payment of benefit

Decision

Decision on secondary competence with article 68 of Regulation (EC) No 883/2004

Decision

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Payment of benefit

Decision

Decision on primary competence with article 58 of Regulation (EC) No 987/2009

Decision

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Decision

Decision on secondary competence with article 58 of Regulation (EC) No 987/2009

Decision

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Decision

Content of decision

Date of decision

Claimant *

Person Identification *

Family name(s) *

Forename(s) *

Date of birth *

Sex *

Family name(s) at birth

Forename(s) at birth

PIN of the person in each institution

Personal Identification Number(s) *

Country *

Personal Identification Number (PIN) *

Sector

Institution

Institution ID *

Institution Name *

Personal Identification Number(s)

If PIN not provided for every institution, please provide

Place of birth

Town *

Region

Country *

Father's family name at birth

Forename of father

Mother's family name at birth

Forename of mother

Additional information about nationality

Nationalities

Nationality *

Since

Nationalities

Addresses of the person

Address of the Person

Type of address

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Address of the Person

Contact Details

Telephone Numbers

Telephone Number

Type

Number *

Telephone Number

Email Addresses

Email Address

Coverage by social security scheme

Periods Covered by security scheme in sending Member State

Period

Start Date *

End Date *

Period

Periods Not covered

Period Not Covered

Start Date *

End Date *

Period Not Covered

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 *

End Date *

Period of Entitlement to family benefit

Reason

Other reason

Family relationship of the claimant to spouse or other person

Relationships

Family relationship

Family Relationship

Other

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Other relationship

Name of person

Date of relationship

Was the claimant a member of the same household as the person in question

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Family relationship

Status of the person

Person is regarded as an active person
Person is regarded as a non-active person
No information about activity of person

Type of Employment *

Periods of Employment *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Type of non-Active Person *

Periods of Non Activity *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Periods of Non Activity *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Additional Information

Employment Periods

Employment period

Start Date *

End Date *

Employment period

Additional information

Periods of pension received in sending Member State

Period of pension received in sending Member State

Type of pension

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period of pension received in sending Member State

Insurance periods in sending Member State

Insurance Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Insurance Period

Grounds for residence

Durations on territory

Duration on territory

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Duration on territory

Moving date into sending Member State

Moving date into receiving Member State

Personal situation elements (article 11 of Regulation (EC) No 987/2009)

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Information on spouse or partner

Person Identification *

Family name(s) *

Forename(s) *

Date of birth *

Sex *

Family name(s) at birth

Forename(s) at birth

PIN of the person in each institution

Personal Identification Number(s) *

Country *

Personal Identification Number (PIN) *

Sector

Institution

Institution ID *

Institution Name *

Personal Identification Number(s)

If PIN not provided for every institution, please provide

Place of birth

Town *

Region

Country *

Father's family name at birth

Forename of father

Mother's family name at birth

Forename of mother

Additional information about nationality

Nationalities

Nationality *

Since

Nationalities

Addresses of the person

Address of the Person

Type of address

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Address of the Person

Contact Details

Telephone Numbers

Telephone Number

Type

Number *

Telephone Number

Email Addresses

Email Address

Coverage by social security scheme

Periods Covered by security scheme in sending Member State

Period

Start Date *

End Date *

Period

Periods Not covered

Period Not Covered

Start Date *

End Date *

Period Not Covered

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 *

End Date *

Period of Entitlement to family benefit

Reason

Other reason

Family relationship of the claimant to spouse or other person

Relationships

Family relationship

Family Relationship

Other

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Other relationship

Name of person

Date of relationship

Was the claimant a member of the same household as the person in question

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Family relationship

Status of the person

Person is regarded as an active person
Person is regarded as a non-active person
No information about activity of person

Type of Employment *

Periods of Employment *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Type of non-Active Person *

Periods of Non Activity *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Periods of Non Activity *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Additional Information

Employment Periods

Employment period

Start Date *

End Date *

Employment period

Additional information

Periods of pension received in sending Member State

Period of pension received in sending Member State

Type of pension

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period of pension received in sending Member State

Insurance periods in sending Member State

Insurance Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Insurance Period

Grounds for residence

Durations on territory

Duration on territory

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Duration on territory

Moving date into sending Member State

Moving date into receiving Member State

Personal situation elements (article 11 of Regulation (EC) No 987/2009)

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Information on other person

Person Identification *

Family name(s) *

Forename(s) *

Date of birth *

Sex *

Family name(s) at birth

Forename(s) at birth

PIN of the person in each institution

Personal Identification Number(s) *

Country *

Personal Identification Number (PIN) *

Sector

Institution

Institution ID *

Institution Name *

Personal Identification Number(s)

If PIN not provided for every institution, please provide

Place of birth

Town *

Region

Country *

Father's family name at birth

Forename of father

Mother's family name at birth

Forename of mother

Additional information about nationality

Nationalities

Nationality *

Since

Nationalities

Addresses of the person

Address of the Person

Type of address

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Address of the Person

Contact Details

Telephone Numbers

Telephone Number

Type

Number *

Telephone Number

Email Addresses

Email Address

Coverage by social security scheme

Periods Covered by security scheme in sending Member State

Period

Start Date *

End Date *

Period

Periods Not covered

Period Not Covered

Start Date *

End Date *

Period Not Covered

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 *

End Date *

Period of Entitlement to family benefit

Reason

Other reason

Family relationship of the claimant to spouse or other person

Relationships

Family relationship

Family Relationship

Other

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Other relationship

Name of person

Date of relationship

Was the claimant a member of the same household as the person in question

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Family relationship

Status of the person

Person is regarded as an active person
Person is regarded as a non-active person
No information about activity of person

Type of Employment *

Periods of Employment *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Type of non-Active Person *

Periods of Non Activity *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Periods of Non Activity *

Period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period

Additional Information

Employment Periods

Employment period

Start Date *

End Date *

Employment period

Additional information

Periods of pension received in sending Member State

Period of pension received in sending Member State

Type of pension

Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Period of pension received in sending Member State

Insurance periods in sending Member State

Insurance Period

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Insurance Period

Grounds for residence

Durations on territory

Duration on territory

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Duration on territory

Moving date into sending Member State

Moving date into receiving Member State

Personal situation elements (article 11 of Regulation (EC) No 987/2009)

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Claiming authority

Reason for authority claim

Claiming authority

Institution ID *

Institution Name *

Bank details

SEPA account*
Non-SEPA account*

IBAN *

BIC-SWIFT

Account number *

BIC-SWIFT *

Bank Name *

Bank Address *

Street

Building Name

Town *

Postal Code

Region

Country *

Information on child(ren) *

Child for whom this decision applies *

Child Details

Family name(s) *

Forename(s) *

Date of birth *

Sex *

Family name(s) at birth

Forename(s) at birth

PIN of the person in each institution

Personal Identification Number(s) *

Country *

Personal Identification Number (PIN) *

Sector

Institution

Institution ID *

Institution Name *

Personal Identification Number(s)

If PIN not provided for every institution, please provide

Place of birth

Town *

Region

Country *

Father's family name at birth

Forename of father

Mother's family name at birth

Forename of mother

Additional information about nationality

Nationalities

Nationality *

Since

Nationalities

Addresses of the child

Address of the Person

Type of address

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Address of the Person

Relationships to claimant, spouse/partner or other person

Relationship per child

Relationship with *

Type *

Period of Relationship

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Joint custody

Child(ren)'s household

Is the child a member of the same household as the claimant

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Is the child a member of the same household as the spouse/partner in question

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Is the child a member of the same household as the other person in question

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Is child in the institution

Relationship per child

Grounds for residence

Durations on territory

Duration on territory

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Duration on territory

Moving date into sending Member State

Moving date into receiving Member State

Personal situation elements (article 11 of Regulation (EC) No 987/2009)

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Child for whom this decision applies

Amounts, names and currencies for family benefits of the Children

Amount, name and currency for family benefits for a child

Name of child

Name of benefit

Family Benefit Details

Amount

Amount *

Currency *

Date for granted benefits

Start Date *

End Date *

Period definition *

Name of beneficiary

Amount, name and currency for family benefits for a child

Amounts of family benefit(s) for the entire family

Amount of Family Benefit

Name of benefit

Number of persons benefits are granted for

Family Benefit Details

Amount

Amount *

Currency *

Date for granted benefits

Start Date *

End Date *

Period definition *

Name of beneficiary

Amount of Family Benefit

Request for offsetting of family benefits for children

Request for offsetting of family benefits for a child

Name of child

Name of benefit

Family Benefit Details

Amount

Amount *

Currency *

Date for granted benefits

Start Date *

End Date *

Period definition *

Name of beneficiary

Grounds of request for overpayment offsetting

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Additional information

Date of decision

Request for offsetting of family benefits for a child

Request for offsetting of family benefits for the entire family

Request for offsetting of family benefit for entire family

Name of benefit

Number of persons benefits are granted for

Family Benefit Details

Amount

Amount *

Currency *

Date for granted benefits

Start Date *

End Date *

Period definition *

Name of beneficiary

Grounds of request for overpayment offsetting

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Additional information

Date of decision

Request for offsetting of family benefit for entire family

Claim for reimbursement with article 58 of Regulation (EC) No 987/2009

Claim

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F001 - Request for determining competence Articles 1(i), 11, 67, 68 of Regulation (EC) No 883/2004; Articles 2(2), 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(5), 72, 73, 74 of Regulation (EC) No 987/2009

F001 - Request for determining competence
Articles 1(i), 11, 67, 68 of Regulation (EC) No 883/2004; Articles 2(2), 6(2), 11, 58, 59, 60(1), 60(2), 60(3), 60(5), 72, 73, 74 of Regulation (EC) No 987/2009