Reply to request for information

R014 - Reply to request for information
Article 76 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

Concerns *

Please fill in the following if "Concerns" = "Person" :
Please fill in the following if "Concerns" = "Employer" :

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

Employer *

Name *

Identification numbers

Identification number

Number *

Type *

Identification number

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Responsible person or section

Contact Information

Telephone Numbers

Telephone Number

Type

Number *

Telephone Number

Email Addresses

Email Address

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

No information

Further information concerning a deceased person

Deceased person details

Person (debtor) deceased on

Heirs or will executors details

Heirs or will executor details

Name of heir or will executor

Address of heir or will executor

Street

Building Name

Town *

Postal Code

Region

Country *

Heirs or will executor details

No information about heirs/will executors can be given

Reason why no information can be given

The person or employer concerned is bankrupt or insolvent

Date of order

Date of release

Bankruptcy or Liquidation details

Name of trustee or liquidator

Address of the trustee or liquidator

Street

Building Name

Town *

Postal Code

Region

Country *

Identity of person or employer concerned

Identity confirmed

The following data about the identity of the person or employer has changed (or is added):

Family name (surname)

Forename(s)

Family name at birth

Forename(s) at birth

Date of birth

Legal status (if a company)

Company name

Address

Address confirmed

The following address data has changed (or is added)

Street

Building Name

Town *

Postal Code

Region

Country *

Financial situation

Income of person

Employment

Employment information

Employer's details

Name *

Identification numbers

Identification number

Number *

Type *

Identification number

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Income details

Payment *

Amount *

Currency *

Payment frequency

Please fill in the following if "Payment frequency" = "Other" :

Other frequency

Employment information

Self-employment

Self-employment information *

Self employer's details

Name *

Identification numbers

Identification number

Number *

Type *

Identification number

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Income details

Payment *

Amount *

Currency *

Payment frequency

Please fill in the following if "Payment frequency" = "Other" :

Other frequency

Self-employment information

Benefits received

Benefit received

Type of benefit *

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

Type of other benefits

Income details

Payment *

Amount *

Currency *

Payment frequency

Please fill in the following if "Payment frequency" = "Other" :

Other frequency

Benefit received

Income of employer

Estimated annual turnover *

Currency *

Property owned by the person or employer concerned

Address of property

Street

Building Name

Town *

Postal Code

Region

Country *

Estimated value

Currency

Other assets

Additional information

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R014 - Reply to request for information Article 76 of Regulation(EC) No 987/2009

R014 - Reply to request for information
Article 76 of Regulation(EC) No 987/2009