A001 - Anmodning om særlig aftale
Artikel 16, stk. 1, i forordning (EF) nr. 883/2004, artikel 18 i forordning (EF) nr. 987/2009
SED API version: 0.16.2 build 2
Model version: 4.2.0
Person
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Identifikation af personen
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Efternavn(e)
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Fornavn(e)
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Fødselsdato
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Køn
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Fornavn(e) ved fødslen
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PIN for personen i hver institution
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Personlige identifikationsnumre
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Land
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Personligt identifikationsnummer (PIN)
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Sektor
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Institution
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Institutionens navn
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Hvis der ikke er oplyst PIN fra hver institution, fremsend den venligst
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Fødested
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By
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Region
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Land
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Faderens fornavn
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Moderens efternavn ved fødslen
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Moderens fornavn
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Yderligere oplysninger om personen
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Statsborgerskab
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Adresser
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Adresse
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Type
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Adresse
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Gade
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Navn på bygning
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By
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Postnummer
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Region
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Land
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Identifikation af arbejdsgiver(e)
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Arbejdsgiver
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Navn
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Identifikationsnumre
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Identifikationsnummer
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Nummer
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Type
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Adresse
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Gade
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Navn på bygning
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By
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Postnummer
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Region
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Land
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Identifikation af selvstændig virksomhed
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Selvstændig virksomhed
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Navn
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Identifikationsnumre
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Identifikationsnummer
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Nummer
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Type
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Adresse
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Gade
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Navn på bygning
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By
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Postnummer
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Region
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Land
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Arbejdssted(er)
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Arbejdssted
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Virksomhedens/skibets navn
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Flagland/Hjemmebase
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Adresse
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Gade
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Navn på bygning
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By
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Postnummer
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Region
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Land
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Ingen fast adresse i arbejdslandet/-landene
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Arbejdsgiver i værtslandet (hvis relevant)
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Navn
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Identifikationsnumre
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Identifikationsnummer
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Nummer
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Type
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Adresse
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Gade
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Navn på bygning
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By
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Postnummer
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Region
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Land
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Ønsket periode
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Startdato
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Slutdato
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Artikler i grundforordningen, som vedrører en situation, hvor der foreslås særlig aftale
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Andet
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Den lovgivning, der skal anvendes
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Yderligere oplysninger
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Anmodningens type
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Ændring
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Dato for tidligere anmodning
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Dato for forudgående anmodning
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Dato
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Forudgående perioder
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Periode
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Fast periode
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Åben periode
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Startdato
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Slutdato
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Type af åben periode
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Startdato
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PD A1 udsedt i henhold til artikel
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Særlige omstændigheder
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Beskrivelse af anden situation
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Startdato for ansættelseskontrakten med den udsendende arbejdsgiver
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Dato, hvor arbejdstager første gang var sikret i udsenderlandet
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Begrundelse
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Yderligere oplysninger
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Yderligere oplysninger
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