Forward Claim for a pension or a supplementary allowance to Competent Institution

DA061 - Forward Claim for a pension or a supplementary allowance to Competent Institution
Article 40(1) of Regulation(EC) No 987/2009

SED API version: 0.16.2 build 2
Model version: 4.2.0

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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Personal Identification Number(s)

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 on the person

Nationality

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Previous family name(s)

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Previous forename(s)

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Institution

Country code

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Details

Institution ID *

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Institution Name *

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Addresses of the person

Address of the person

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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Type of address

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Address of the person

Date of submission of the claim *

Date *

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Survivors submitting the claim *

Survivor submitting the claim *

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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Personal Identification Number(s)

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 on the person

Nationality

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Addresses of the survivor

Address of the person

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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Type of address

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Address of the person

Addresses of the survivor

Survivor submitting the claim

Additional information

Additional information

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