Atmaksāšanas pieprasījums - pabalsti natūrā (CLA)

DA010 - Atmaksāšanas pieprasījums - pabalsti natūrā (CLA)
Regulas (EK) Nr. 883/2004 35. un 41. pants, Regulas (EK) Nr. 987/2009 62. pants, 66. panta 1. punkts, 67. pants

SED API version: 0.16.2 build 2
Model version: 4.2.0

Global note - CLA * [ SED ]

Kopējā CLA atsauce - kreditora sadarbības struktūra *

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Kopējais atsevišķo pieprasījumu skaits *

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Pabalstu kopsumma * [ CC ]

Summa *

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Valūta *

[ ENUM ] {{metaSection.currency.$$error}} {{metaSection.currency.$$warning}}

Pusgada numurs kreditora iestādē *

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Finanšu gada numurs kreditora iestādē *

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Bankas konts - kreditora sadarbības iestāde * [ CC ]

IBAN *

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BIC-SWIFT

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Iesniegšanas datums *

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Atsevišķie CLA * [ SED ]

Atsevišķs CLA * [ SED ]

Kreditoriestādes identifikācijas numurs * [ CC ]

Iestādes identifikācijas numurs *

[ BDT ] {{metaSection.institutionID.$$error}} {{metaSection.institutionID.$$warning}}

Iestādes nosaukums *

[ CDT ] {{metaSection.institutionName.$$error}} {{metaSection.institutionName.$$warning}}

Debitora iestādes identifikācijas numurs * [ CC ]

Iestādes identifikācijas numurs *

[ BDT ] {{metaSection.institutionID.$$error}} {{metaSection.institutionID.$$warning}}

Iestādes nosaukums *

[ CDT ] {{metaSection.institutionName.$$error}} {{metaSection.institutionName.$$warning}}

Atsauces * [ SED ]

Kopējā CLA atsauce - kreditora sadarbības struktūra *

[ BDT ] {{metaSection.globalCLAReferenceCreditorLiaisonBody.$$error}} {{metaSection.globalCLAReferenceCreditorLiaisonBody.$$warning}}

Atsevišķais CLA numurs - kreditora sadarbības struktūra *

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Datums, kad kreditora iestāde reģistrēja CLA *

[ BDT ] {{metaSection.dateCreditorInstitutionRecordedCLA.$$error}} {{metaSection.dateCreditorInstitutionRecordedCLA.$$warning}}

Persona, kas saņem pabalstus * [ CC ]

Personas informācija * [ CC ]

Uzvārds(-i) *

[ BDT ] {{metaSection.familyName.$$error}} {{metaSection.familyName.$$warning}}

Vārds(-i) *

[ BDT ] {{metaSection.forename.$$error}} {{metaSection.forename.$$warning}}

Dzimšanas datums *

[ BDT ] {{metaSection.dateBirth.$$error}} {{metaSection.dateBirth.$$warning}}

Dzimums *

[ ENUM ] {{metaSection.sex.$$error}} {{metaSection.sex.$$warning}}

Dzimtais uzvārds

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Dzimtais vārds

[ BDT ] {{metaSection.forenameAtBirth.$$error}} {{metaSection.forenameAtBirth.$$warning}}

Personas identifikācijas numurs * [ CC ]

Personas identifikācijas numurs kompetentajā dalībvalstī *

[ BDT ] {{metaSection.pINPersonInCompetentMemberState.$$error}} {{metaSection.pINPersonInCompetentMemberState.$$warning}}

Personas identifikācijas numurs dzīvesvietas vai uzturēšanās vietas dalībvalstī

[ BDT ] {{metaSection.pINPersonInMemberStateStayOrResidence.$$error}} {{metaSection.pINPersonInMemberStateStayOrResidence.$$warning}}

Tiesības apliecinošs dokuments * [ SED ]

Tiesības apliecinošs dokuments *

[ ENUM ] {{metaSection.entitlementDocument.$$error}} {{metaSection.entitlementDocument.$$warning}}

Tiesību derīguma periods * [ CC ]

Fiksēts periods * [ CC ]

Kārtējais periods * [ CC ]

Sākuma datums *

[ BDT ] {{metaSection.startDate.$$error}} {{metaSection.startDate.$$warning}}

Beigu datums *

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Kārtējā perioda veids *

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Sākuma datums *

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Sniegtie pabalsti * [ SC ]

Pabalsts, kas saistīts ar *

[ ENUM ] {{metaSection.benefitRelatedTo.$$error}} {{metaSection.benefitRelatedTo.$$warning}}

Datums *

[ BDT ] {{metaSection.date.$$error}} {{metaSection.date.$$warning}}

Pabalstu periods * [ CC ]

Sākuma datums *

[ BDT ] {{metaSection.startDate.$$error}} {{metaSection.startDate.$$warning}}

Beigu datums *

[ BDT ] {{metaSection.endDate.$$error}} {{metaSection.endDate.$$warning}}

Detalizēta pabalstu summa * [ SC ]

Summa par medicīnas aprūpi

[ BDT ] {{metaSection.medicalCareAmount.$$error}} {{metaSection.medicalCareAmount.$$warning}}

Izmaksas par zālēm

[ BDT ] {{metaSection.medicineAmount.$$error}} {{metaSection.medicineAmount.$$warning}}

Summa par zobārstniecības pakalpojumiem

[ BDT ] {{metaSection.dentalCareAmount.$$error}} {{metaSection.dentalCareAmount.$$warning}}

Ilgtermiņa aprūpes pabalsta summa

[ BDT ] {{metaSection.longTermCareAmount.$$error}} {{metaSection.longTermCareAmount.$$warning}}

Hospitalizācijas pabalsti [ SC ]

Hospitalizācijas pabalsts [ SC ]

Hospitalizācijas periods [ CC ]

Sākuma datums *

[ BDT ] {{metaSection.startDate.$$error}} {{metaSection.startDate.$$warning}}

Beigu datums *

[ BDT ] {{metaSection.endDate.$$error}} {{metaSection.endDate.$$warning}}

Hospitalizācijas izmaksas *

[ BDT ] {{metaSection.hospitalisationAmount.$$error}} {{metaSection.hospitalisationAmount.$$warning}}

Hospitalizācijas pabalsts

Cits pabalsts(-i) [ SC ]

Cits pabalsts [ SC ]

Cita pabalsta apraksts *

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Citu pabalstu summa *

[ BDT ] {{metaSection.otherBenefitsAmount.$$error}} {{metaSection.otherBenefitsAmount.$$warning}}

Cits pabalsts

Pabalstu kopsumma * [ CC ]

Summa *

[ BDT ] {{metaSection.amount.$$error}} {{metaSection.amount.$$warning}}

Valūta *

[ ENUM ] {{metaSection.currency.$$error}} {{metaSection.currency.$$warning}}

Atsevišķs CLA

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DA010 - Atmaksāšanas pieprasījums - pabalsti natūrā (CLA) Regulas (EK) Nr. 883/2004 35. un 41. pants, Regulas (EK) Nr. 987/2009 62. pants, 66. panta 1. punkts, 67. pants

DA010 - Atmaksāšanas pieprasījums - pabalsti natūrā (CLA)
Regulas (EK) Nr. 883/2004 35. un 41. pants, Regulas (EK) Nr. 987/2009 62. pants, 66. panta 1. punkts, 67. pants