Request for deductions from arrears/ongoing payments

R001 - Request for deductions from arrears/ongoing payments
Article 72(1) of Regulation (EC) No 987/2009

SED API version: 0.16.2 build 2
Model version: 4.2.0

Local case numbers

Local Case Number

Country *

Case number *

Institution

Institution ID *

Institution Name *

Local Case Number

Persons *

Person *

Person Identification *

Family name(s) *

Forename(s) *

Date of birth *

Sex *

Family name(s) at birth

Forename(s) at birth

PIN of the person in each institution

Personal Identification Number(s) *

Country *

Personal Identification Number (PIN) *

Sector

Institution

Institution ID *

Institution Name *

Personal Identification Number(s)

If PIN not provided for every institution, please provide

Place of birth

Town *

Region

Country *

Father's family name at birth

Forename of father

Mother's family name at birth

Forename of mother

Additional information about a person *

Status of the person *

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

Other status of the person

Nationality

Previous family name(s)

Previous forenames

Previous forename

Current family status

Date of death

Person's last known addresses

Person's last known address details *

Type of address *

Please fill in the following if "Type of address" = "Other" :

Specify "Other" Type

Address detail *

Street

Building Name

Town *

Postal Code

Region

Country *

Person's last known address details

Person

Type of request *

Benefits received unduly *

Type of benefit

Please fill in the following if "Type of benefit" = "Other benefit" :

Type of other benefits

Please fill in the following if "Type of request" = "Final" :

Overpayment periods

Overpayment period

Period

Start Date *

End Date *

Date of decision

Reason for overpayment *

Please fill in the following if "Reason for overpayment" = "Other"

Other reason

Overpayment period

Payment amount

Overpaid amount for whole period *

Amount *

Currency *

Detailed information about overpaid amounts

Detailed information about overpaid amount

Start date *

Details

Frequency *

Please fill in the following if "Frequency" = "Other" :

Other frequency

Number of periodic units *

Amount per unit *

Amount *

Currency *

Detailed information about overpaid amount

Benefit deduction

Type of benefit

Please fill in the following if "Type of benefit" = "Other benefit" :

Type of other benefits

Deduction from arrears

Deduction from arrears possible *

{{metaSection.deductionFromArrearsPossibleIndicator.$$error}} {{metaSection.deductionFromArrearsPossibleIndicator.$$warning}}

Please fill in the following if "Deduction from arrears possible" = "Yes" :

Detailed information about deductions from arrears

Detailed information about deduction from arrears

Start date

Details

Frequency *

Please fill in the following if "Frequency" = "Other" :

Other frequency

Number of periodic units *

Amount per unit *

Amount *

Currency *

Detailed information about deduction from arrears

Deduction from ongoing payments

Deduction in general possible *

{{metaSection.deductionInGeneralPossibleIndicator.$$error}} {{metaSection.deductionInGeneralPossibleIndicator.$$warning}}

Detailed information about deduction from ongoing payments

Frequency *

Please fill in the following if "Frequency" = "Other" :

Other frequency

Number of periodic units *

Amount per unit *

Amount *

Currency *

Additional information

Please fill in the following if "Type of request" = "Final" :

Bank details

SEPA Bank details *

IBAN *

BIC-SWIFT

Account holder name *

Payment reference *

Receiving bank address

Street

Building Name

Town *

Postal Code

Region

Country *

{{ row.severityMessage }} : {{ row.message }}

R001 - Request for deductions from arrears/ongoing payments Article 72(1) of Regulation (EC) No 987/2009

R001 - Request for deductions from arrears/ongoing payments
Article 72(1) of Regulation (EC) No 987/2009