F017 - Reply to request to discharge of benefits
Article 68a of Regulation (EC) No 883/2004
SED API version: 0.16.2 build 2
Model version: 4.2.0
Reply to request
Request accepted from
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Payment of benefits starts
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Request not accepted from
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Legal grounds
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Additional information
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Former beneficiary
*
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
{{$select.selected[ 'name']}}
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{{metaSection.sector.$$warning}}
Institution
Institution ID
*
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{{metaSection.institutionID.$$warning}}
Institution Name
*
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If PIN not provided for every institution, please provide
Place of birth
Town
*
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Region
{{metaSection.region.$$error}}
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Country
*
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Father's family name at birth
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Forename of father
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Mother's family name at birth
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{{metaSection.motherFamilyNameAtBirth.$$warning}}
Forename of mother
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{{metaSection.forenameMother.$$warning}}
Additional information about nationality
Nationalities
Nationality
*
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Since
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Addresses of the person
Address of the Person
Type of address
{{option.name}}
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{{metaSection.typeAddress.$$warning}}
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
*
{{$select.selected[ 'name']}}
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Contact Details
Telephone Numbers
Telephone Number
Type
{{option.name}}
{{metaSection.type.$$error}}
{{metaSection.type.$$warning}}
Number
*
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{{metaSection.number.$$warning}}
Email Addresses
Email Address
Email Address
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{{metaSection.email.$$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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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
{{option.name}}
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Other reason
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Approved Beneficiary
Approved Beneficiary
{{option.name}}
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Information on spouse or partner
Person Identification
*
Family name(s)
*
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
Forename(s)
*
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
Date of birth
*
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{{metaSection.dateBirth.$$warning}}
Sex
*
{{option.name}}
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Family name(s) at birth
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
Forename(s) at birth
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{{metaSection.forenameAtBirth.$$warning}}
PIN of the person in each institution
Personal Identification Number(s)
*
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Personal Identification Number (PIN)
*
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
Sector
{{$select.selected[ 'name']}}
{{metaSection.sector.$$error}}
{{metaSection.sector.$$warning}}
Institution
Institution ID
*
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Institution Name
*
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
If PIN not provided for every institution, please provide
Place of birth
Town
*
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Region
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Father's family name at birth
{{metaSection.fatherFamilyNameAtBirth.$$error}}
{{metaSection.fatherFamilyNameAtBirth.$$warning}}
Forename of father
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{{metaSection.forenameFather.$$warning}}
Mother's family name at birth
{{metaSection.motherFamilyNameAtBirth.$$error}}
{{metaSection.motherFamilyNameAtBirth.$$warning}}
Forename of mother
{{metaSection.forenameMother.$$error}}
{{metaSection.forenameMother.$$warning}}
Additional information about nationality
Nationalities
Nationality
*
{{$select.selected[ 'name']}}
{{metaSection.nationality.$$error}}
{{metaSection.nationality.$$warning}}
Since
{{metaSection.since.$$error}}
{{metaSection.since.$$warning}}
Addresses of the person
Address of the Person
Type of address
{{option.name}}
{{metaSection.typeAddress.$$error}}
{{metaSection.typeAddress.$$warning}}
Address
Street
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
Building Name
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
Town
*
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{{metaSection.town.$$warning}}
Postal Code
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Region
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Contact Details
Telephone Numbers
Telephone Number
Type
{{option.name}}
{{metaSection.type.$$error}}
{{metaSection.type.$$warning}}
Number
*
{{metaSection.number.$$error}}
{{metaSection.number.$$warning}}
Email Addresses
Email Address
Email Address
{{metaSection.email.$$error}}
{{metaSection.email.$$warning}}
Coverage by social security scheme
Periods Covered by security scheme in sending Member State
Period
Start Date
*
{{metaSection.startDate.$$error}}
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End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Periods Not covered
Period Not Covered
Start Date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Periods of Entitlement
Entitlement to Family Benefits, if yes
If no entitlement, choose one reason
Period Entitlement Family Benefits
Period of Entitlement to family benefit
Start Date
*
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{{metaSection.startDate.$$warning}}
End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Reason
{{option.name}}
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Other reason
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Information on other person
Person Identification
*
Family name(s)
*
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
Forename(s)
*
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
Date of birth
*
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
Sex
*
{{option.name}}
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
Family name(s) at birth
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
Forename(s) at birth
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
PIN of the person in each institution
Personal Identification Number(s)
*
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Personal Identification Number (PIN)
*
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
Sector
{{$select.selected[ 'name']}}
{{metaSection.sector.$$error}}
{{metaSection.sector.$$warning}}
Institution
Institution ID
*
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Institution Name
*
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
If PIN not provided for every institution, please provide
Place of birth
Town
*
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Region
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Father's family name at birth
{{metaSection.fatherFamilyNameAtBirth.$$error}}
{{metaSection.fatherFamilyNameAtBirth.$$warning}}
Forename of father
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{{metaSection.forenameFather.$$warning}}
Mother's family name at birth
{{metaSection.motherFamilyNameAtBirth.$$error}}
{{metaSection.motherFamilyNameAtBirth.$$warning}}
Forename of mother
{{metaSection.forenameMother.$$error}}
{{metaSection.forenameMother.$$warning}}
Additional information about nationality
Nationalities
Nationality
*
{{$select.selected[ 'name']}}
{{metaSection.nationality.$$error}}
{{metaSection.nationality.$$warning}}
Since
{{metaSection.since.$$error}}
{{metaSection.since.$$warning}}
Addresses of the person
Address of the Person
Type of address
{{option.name}}
{{metaSection.typeAddress.$$error}}
{{metaSection.typeAddress.$$warning}}
Address
Street
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
Building Name
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
Town
*
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Postal Code
{{metaSection.postalCode.$$error}}
{{metaSection.postalCode.$$warning}}
Region
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Contact Details
Telephone Numbers
Telephone Number
Type
{{option.name}}
{{metaSection.type.$$error}}
{{metaSection.type.$$warning}}
Number
*
{{metaSection.number.$$error}}
{{metaSection.number.$$warning}}
Email Addresses
Email Address
Email Address
{{metaSection.email.$$error}}
{{metaSection.email.$$warning}}
Coverage by social security scheme
Periods Covered by security scheme in sending Member State
Period
Start Date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Periods Not covered
Period Not Covered
Start Date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Periods of Entitlement
Entitlement to Family Benefits, if yes
If no entitlement, choose one reason
Period Entitlement Family Benefits
Period of Entitlement to family benefit
Start Date
*
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
End Date
*
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Reason
{{option.name}}
{{metaSection.reason.$$error}}
{{metaSection.reason.$$warning}}
Other reason
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{{metaSection.otherReason.$$warning}}
Claiming authority
Reason for authority claim
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Claiming authority
Institution ID
*
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{{metaSection.institutionID.$$warning}}
Institution Name
*
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Bank details
SEPA account
*
Non-SEPA account
*
IBAN
*
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BIC-SWIFT
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Account number
*
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BIC-SWIFT
*
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Bank Name
*
{{metaSection.bankName.$$error}}
{{metaSection.bankName.$$warning}}
Bank Address
*
Street
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{{metaSection.street.$$warning}}
Building Name
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{{metaSection.buildingName.$$warning}}
Town
*
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{{metaSection.town.$$warning}}
Postal Code
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{{metaSection.postalCode.$$warning}}
Region
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{{metaSection.region.$$warning}}
Country
*
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Information on child(ren)
Child
*
Child Details
*
Family name(s)
*
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{{metaSection.familyName.$$warning}}
Forename(s)
*
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
Date of birth
*
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
Sex
*
{{option.name}}
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
Family name(s) at birth
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
Forename(s) at birth
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
PIN of the person in each institution
Personal Identification Number(s)
*
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Personal Identification Number (PIN)
*
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
Sector
{{$select.selected[ 'name']}}
{{metaSection.sector.$$error}}
{{metaSection.sector.$$warning}}
Institution
Institution ID
*
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Institution Name
*
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
If PIN not provided for every institution, please provide
Place of birth
Town
*
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Region
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Country
*
{{$select.selected[ 'name']}}
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Father's family name at birth
{{metaSection.fatherFamilyNameAtBirth.$$error}}
{{metaSection.fatherFamilyNameAtBirth.$$warning}}
Forename of father
{{metaSection.forenameFather.$$error}}
{{metaSection.forenameFather.$$warning}}
Mother's family name at birth
{{metaSection.motherFamilyNameAtBirth.$$error}}
{{metaSection.motherFamilyNameAtBirth.$$warning}}
Forename of mother
{{metaSection.forenameMother.$$error}}
{{metaSection.forenameMother.$$warning}}
Additional information about nationality
Nationalities
Nationality
*
{{$select.selected[ 'name']}}
{{metaSection.nationality.$$error}}
{{metaSection.nationality.$$warning}}
Since
{{metaSection.since.$$error}}
{{metaSection.since.$$warning}}
Addresses of the child
Address of the Person
Type of address
{{option.name}}
{{metaSection.typeAddress.$$error}}
{{metaSection.typeAddress.$$warning}}
Address
Street
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
Building Name
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
Town
*
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{{metaSection.town.$$warning}}
Postal Code
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{{metaSection.postalCode.$$warning}}
Region
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{{metaSection.region.$$warning}}
Country
*
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