Inventory of months relating to reimbursement on the basis of fixed amounts (IMO)

S100 - Inventory of months relating to reimbursement on the basis of fixed amounts (IMO)
Articles 63, 64, 65, 66, 67 of Regulation (EC) No 987/2009

SED API version: 0.16.2 build 2
Model version: 4.2.0

Global Note IMO *

Global IMO Reference Creditor Liaison Body *

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Total number of individual claims *

Total number of months *

Financial year *

Lump sum legal category *

Lump sum category based on the person status *

Please fill in the following if "Lump sum legal category" = "01 - IR 987/2009, Art 63, 2.a" :

Lump sum category

Please fill in the following if "Lump sum legal category" = "02 - IR 987/2009, Art 63, 2.b" :

Lump sum category

Date of submission *

Individual IMOs *

Individual IMO *

ID Creditor Institution *

Institution ID *

Institution Name *

ID Debtor Institution *

Institution ID *

Institution Name *

References *

Global IMO Reference Creditor Liaison Body *

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Individual IMO 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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Entitlement document *

Validity period *

Fixed period*
Open period*

Start date *

End date *

Type of Open Period *

Start date *

Accounting period *

Start Date *

End Date *

Number of months *

Date of issue IMO of institution in place of residence *

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Individual IMO

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S100 - Inventory of months relating to reimbursement on the basis of fixed amounts (IMO) Articles 63, 64, 65, 66, 67 of Regulation (EC) No 987/2009

S100 - Inventory of months relating to reimbursement on the basis of fixed amounts (IMO)
Articles 63, 64, 65, 66, 67 of Regulation (EC) No 987/2009