Reply to request for information

H002 - Reply to request for information
Article 76 of Regulation (EC) No 883/2004

SED API version: 0.16.2 build 2
Model version: 4.2.0

Reply to request for information *

Person*
Employer*
Reimbursement Bulk SED*

Person identification *

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 on the person

Nationality

Status of the person

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

Other

Address of the person

Type of Address

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Address of the person

Information for identification of the person

Person

Family name(s)

Forename(s)

Birth date

Sex

Family name(s) at birth

Forename(s) at birth

Place of birth

Town *

Region

Country *

Father's family name at birth

Forename of father

Mother's family name at birth

Forename of mother

Previous family name(s)

Previous forename(s)

Sector PIN (Personal Identification Number of the sending institution)

All

Sickness in cash

Sickness in kind

Pension

Unemployment

Occupational disease and accident at work, benefits in cash

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Occupational disease and accident at work, benefits in kind

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Family benefits

Recovery

National Tax number

Other sector PIN

Please fill in the following if "Sector PIN"="Other sector PIN":

Description of other sector

Positive reply to requested information

We are enclosing

The following document(s)

The following information

The following SED(s)

Negative reply to requested information

We are unable to send

The following document(s)

The following information

The following SED(s)

Reasons

We are unable to send

Additional information

Please find attached the following documents:

Predefined Documents

Other Document

Document

Other Document

Employer *

Name *

Identification numbers

Identification number

Number *

Type *

Identification number

Address

Street

Building Name

Town *

Postal Code

Region

Country *

Positive reply to requested information

We are enclosing

The following document(s)

The following information

The following SED(s)

Negative reply to requested information

We are unable to send

The following document(s)

The following information

The following SED(s)

Reasons

We are unable to send

Additional information

Please find attached the following documents:

Predefined Documents

Other Document

Document

Other Document

Reimbursement identification *

Reimbursement Request ID *

Positive reply to requested information

We are enclosing

The following document(s)

The following information

The following SED(s)

Negative reply to requested information

We are unable to send

The following document(s)

The following information

The following SED(s)

Reasons

We are unable to send

Additional information

Please find attached the following documents:

Predefined Documents

Other Document

Document

Other Document

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H002 - Reply to request for information Article 76 of Regulation (EC) No 883/2004

H002 - Reply to request for information
Article 76 of Regulation (EC) No 883/2004