Reply to request for information on employment/self-employment/residence periods - special non-contributory cash benefits

M053 - Reply to request for information on employment/self-employment/residence periods - special non-contributory cash benefits
Article 70 of Regulation (EC) No 883/2004

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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Status of the person

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Please fill in the following if "Status of the person" = "Other" :

Other status

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Address of the person

Type of address

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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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Pursues a professional or trade activity

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The person named in section 1 has completed

Periods of employment

Start Date *

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End Date *

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Periods of employment

Periods of self-employment

Start Date *

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End Date *

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Periods of self-employment

Periods of residence in the country of sending institution

Period

Start Date *

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End Date *

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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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Periods of residence in the country of sending institution

Additional Information

Additional Information

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Please find attached following document(s)

Attached document(s)

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Other document(s)

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