H020 - Begäran om - återbetalning - administrativ kontroll/medicinsk information
Artikel 87 i förordning (EG) nr 987/2009
SED API version: 0.16.2 build 2
Model version: 4.2.0
Total fordran
*
[ SED ]
Borgenärinstitution
*
[ CC ]
Institutionens ID
*
[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Institutionens namn
*
[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Allmän referens som anges av borgenärinstitutionen
*
[ CDT ]
{{metaSection.globalReferenceSetByCreditorInstitution.$$error}}
{{metaSection.globalReferenceSetByCreditorInstitution.$$warning}}
Totalt antal fakturor
*
[ PRIM ]
{{metaSection.totalNumberInvoices.$$error}}
{{metaSection.totalNumberInvoices.$$warning}}
Totalt fordringsbelopp i borgenärinstitutionens valuta
*
[ SED ]
Belopp
*
[ BDT ]
{{metaSection.amount.$$error}}
{{metaSection.amount.$$warning}}
Valuta
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.currency.$$error}}
{{metaSection.currency.$$warning}}
Betalningen förfaller den
[ BDT ]
{{metaSection.paymentDueOn.$$error}}
{{metaSection.paymentDueOn.$$warning}}
Gäldenärinstitution
[ CC ]
Institutionens ID
*
[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Institutionens namn
*
[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Bankuppgifter
[ CC ]
IBAN
*
[ BDT ]
{{metaSection.IBAN.$$error}}
{{metaSection.IBAN.$$warning}}
BIC-Swift
[ BDT ]
{{metaSection.BICSWIFT.$$error}}
{{metaSection.BICSWIFT.$$warning}}
Fordran
[ SED ]
Person
*
[ CC ]
Personuppgifter
*
[ CC ]
Efternamn
*
[ BDT ]
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
Förnamn
*
[ BDT ]
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
Födelsedatum
*
[ BDT ]
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
Kön
*
{{option.name}}
[ ENUM ]
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
Efternamn vid födseln
[ BDT ]
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
Förnamn vid födseln
[ BDT ]
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
Personens identifieringsnummer
*
[ CC ]
Personens PIN i den behöriga medlemsstaten
*
[ BDT ]
{{metaSection.pINPersonInCompetentMemberState.$$error}}
{{metaSection.pINPersonInCompetentMemberState.$$warning}}
Personens PIN i vistelsemedlemsstaten eller bosättningsmedlemsstaten
[ BDT ]
{{metaSection.pINPersonInMemberStateStayOrResidence.$$error}}
{{metaSection.pINPersonInMemberStateStayOrResidence.$$warning}}
Ersättning
*
[ SED ]
Med hänvisning till er
*
{{option.name}}
[ ENUM ]
{{metaSection.inReferenceYour.$$error}}
{{metaSection.inReferenceYour.$$warning}}
Utfärdad den
*
[ BDT ]
{{metaSection.issuedOn.$$error}}
{{metaSection.issuedOn.$$warning}}
Borgenärinstitutionens fakturanummer
*
[ CDT ]
{{metaSection.invoiceNumberCreditorInstitution.$$error}}
{{metaSection.invoiceNumberCreditorInstitution.$$warning}}
Fakturabelopp i borgenärinstitutionens valuta
*
[ CC ]
Belopp
*
[ BDT ]
{{metaSection.amount.$$error}}
{{metaSection.amount.$$warning}}
Valuta
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.currency.$$error}}
{{metaSection.currency.$$warning}}