Reply on contestation of individual claim (RPY

S084 - Reply on contestation of individual claim (RPY_COC)
Articles 62, 66(1), 67 of Regulation (EC) No 987/2009

SED API version: 0.16.2 build 2
Model version: 4.2.0

Global note RPY_COC *

Global CLA Reference Creditor Liaison Body *

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Global COC Reference Debtor Liaison Body *

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Global RPY_COC Reference Creditor Liaison Body *

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Total Number Of Contestation Replies *

Total amount of accepted contestations *

Amount *

Currency *

Date Of Submission *

Individual RPY_COCs *

Individual RPY_COC *

ID Creditor Institution *

Institution ID *

Institution Name *

ID Debtor Institution *

Institution ID *

Institution Name *

References *

Global CLA Reference Creditor Liaison Body *

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Global COC Reference Debtor Liaison Body *

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Global RPY_COC Reference Creditor Liaison Body *

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Individual CLA number Creditor Liaison Body *

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Individual COC number Debtor Liaison Body *

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Individual RPY_COC number Creditor Liaison Body *

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Person receiving benefits *

Person Information *

Family name(s) *

Forename(s) *

Date of birth *

Sex *

Family name(s) at birth

Forename(s) at birth

Person Identification Number *

PIN of the person in Competent Member State *

PIN of the person in Member State of Stay or Residence

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Contestation Reply Code *

Please fill in the following if "Contestation reply code" = "03 - Contestation after deadline, received on" or "06 - The primary entitlement in state of residence starts on" :
Please fill in the following if "Contestation reply code" = "99 - Other" :
Please fill in the following if "Contestation reply code" = " 01 - Contestation accepted in full and invoice concerned is decreased " OR "02 - Contestation partially accepted and invoice concerned is decreased" :

Contestation Reply Code Date

Contestation Reply Code Other

Benefits after accepted contestation

Nature of benefits *

Benefits Period *

Start Date *

End Date *

All Benefits Amount *

Medical Care Amount

Medicine Amount

Dental Care Amount

Long-term Care Amount

Hospitalisation Benefits

Hospitalisation benefit

Hospitalisation period

Start Date *

End Date *

Hospitalisation Amount *

Hospitalisation benefit

Other benefit(s)

Other benefit

Other Benefit Description *

Other Benefits Amount *

Other benefit

Individual amount accepted contestations *

Amount *

Currency *

Individual RPY_COC

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S084 - Reply on contestation of individual claim (RPY_COC) Articles 62, 66(1), 67 of Regulation (EC) No 987/2009

S084 - Reply on contestation of individual claim (RPY_COC)
Articles 62, 66(1), 67 of Regulation (EC) No 987/2009