R011 - Antwoord met bedrag van terug te betalen bijdragen
Artikel 73, lid 2, van Verordening (EG) nr. 987/2009
SED API version: 0.16.2 build 2
Model version: 4.2.0
Lokale dossiernummers
[ CC ]
Lokaal dossiernummer
[ CC ]
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Zaaknummer
*
[ CDT ]
{{metaSection.caseNumber.$$error}}
{{metaSection.caseNumber.$$warning}}
Orgaan
[ CC ]
Identificatienummer van het orgaan
*
[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Naam orgaan
*
[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Betreft
*
[ SC ]
Betreft
*
{{option.name}}
[ ENUM ]
{{metaSection.concerns.$$error}}
{{metaSection.concerns.$$warning}}
Gelieve in te vullen als "Betreft" = "Persoon":
[ SED ]
Gelieve in te vullen als "Betreft" = "Werkgever":
[ SC ]
Personen
[ SC ]
Persoon
*
[ SC ]
Identificatie persoon
*
[ CC ]
Achternaam/-namen
*
[ BDT ]
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
Voornaam/-namen
*
[ BDT ]
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
Geboortedatum
*
[ BDT ]
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
Geslacht
*
{{option.name}}
[ ENUM ]
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
Achternaam/-namen bij de geboorte
[ BDT ]
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
Voornaam/-namen bij de geboorte
[ BDT ]
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
PIN van de persoon bij elk orgaan
[ CC ]
Persoonlijk(e) identificatienummer(s)
*
[ CC ]
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Persoonlijk identificatienummer (PIN)
*
[ BDT ]
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
Sector
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.sector.$$error}}
{{metaSection.sector.$$warning}}
Orgaan
[ CC ]
Identificatienummer van het orgaan
*
[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Naam orgaan
*
[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Indien niet voor elke instantie PIN is vermeld, invullen a.u.b.
[ CC ]
Geboorteplaats
[ CC ]
Plaats
*
[ CDT ]
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Regio
[ CDT ]
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Familienaam vader bij de geboorte
[ BDT ]
{{metaSection.fatherFamilyNameAtBirth.$$error}}
{{metaSection.fatherFamilyNameAtBirth.$$warning}}
Voornaam vader
[ BDT ]
{{metaSection.forenameFather.$$error}}
{{metaSection.forenameFather.$$warning}}
Achternaam moeder bij de geboorte
[ BDT ]
{{metaSection.motherFamilyNameAtBirth.$$error}}
{{metaSection.motherFamilyNameAtBirth.$$warning}}
Voornaam moeder
[ BDT ]
{{metaSection.forenameMother.$$error}}
{{metaSection.forenameMother.$$warning}}
Aanvullende informatie over een persoon
*
[ SC ]
Status van de persoon
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.statusPerson.$$error}}
{{metaSection.statusPerson.$$warning}}
Gelieve in te vullen als "Status van de persoon" = "Andere":
[ SC ]
Andere status van de persoon
[ CDT ]
{{metaSection.otherStatusPerson.$$error}}
{{metaSection.otherStatusPerson.$$warning}}
Nationaliteit
[ ENUM ]
{{metaSection.nationality.$$error}}
{{metaSection.nationality.$$warning}}
Vroegere achternaam/-namen
[ SC ]
Vroegere achternaam/-namen
[ SC ]
Vroegere achternaam/-namen
[ BDT ]
{{metaSection.previousFamilyName.$$error}}
{{metaSection.previousFamilyName.$$warning}}
Vorige voornamen
[ SC ]
Vroegere voornaam
[ SC ]
Vroegere voornaam
[ BDT ]
{{metaSection.previousForename.$$error}}
{{metaSection.previousForename.$$warning}}
Huidige gezinssituatie
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.currentFamilyStatus.$$error}}
{{metaSection.currentFamilyStatus.$$warning}}
Datum van overlijden
[ BDT ]
{{metaSection.dateDeath.$$error}}
{{metaSection.dateDeath.$$warning}}
Werkgever
*
[ CC ]
Naam
*
[ CDT ]
{{metaSection.name.$$error}}
{{metaSection.name.$$warning}}
Identificatienummers
[ CC ]
Identificatienummer
[ CC ]
Nummer
*
[ CDT ]
{{metaSection.number.$$error}}
{{metaSection.number.$$warning}}
Soort
*
{{option.name}}
[ ENUM ]
{{metaSection.type.$$error}}
{{metaSection.type.$$warning}}
Adres
[ CC ]
Straat
[ CDT ]
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
Naam van het gebouw
[ CDT ]
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
Plaats
*
[ CDT ]
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Postcode
[ CDT ]
{{metaSection.postalCode.$$error}}
{{metaSection.postalCode.$$warning}}
Regio
[ CDT ]
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Verantwoordelijke persoon of afdeling
[ SC ]
Verantwoordelijke persoon of afdeling
[ CDT ]
{{metaSection.responsiblePersonOrSection.$$error}}
{{metaSection.responsiblePersonOrSection.$$warning}}
Contactgegevens
[ CC ]
Telefoonnummers
[ CC ]
Telefoonnummer
[ CC ]
Soort
{{option.name}}
[ ENUM ]
{{metaSection.type.$$error}}
{{metaSection.type.$$warning}}
Nummer
*
[ BDT ]
{{metaSection.number.$$error}}
{{metaSection.number.$$warning}}
E-mailadressen
[ CC ]
E-mailadres
[ CC ]
E-mailadres
[ BDT ]
{{metaSection.email.$$error}}
{{metaSection.email.$$warning}}
Personen
[ SC ]
Persoon
*
[ SC ]
Identificatie persoon
*
[ CC ]
Achternaam/-namen
*
[ BDT ]
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
Voornaam/-namen
*
[ BDT ]
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
Geboortedatum
*
[ BDT ]
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
Geslacht
*
{{option.name}}
[ ENUM ]
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
Achternaam/-namen bij de geboorte
[ BDT ]
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
Voornaam/-namen bij de geboorte
[ BDT ]
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
PIN van de persoon bij elk orgaan
[ CC ]
Persoonlijk(e) identificatienummer(s)
*
[ CC ]
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Persoonlijk identificatienummer (PIN)
*
[ BDT ]
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
Sector
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.sector.$$error}}
{{metaSection.sector.$$warning}}
Orgaan
[ CC ]
Identificatienummer van het orgaan
*
[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Naam orgaan
*
[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Indien niet voor elke instantie PIN is vermeld, invullen a.u.b.
[ CC ]
Geboorteplaats
[ CC ]
Plaats
*
[ CDT ]
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Regio
[ CDT ]
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Familienaam vader bij de geboorte
[ BDT ]
{{metaSection.fatherFamilyNameAtBirth.$$error}}
{{metaSection.fatherFamilyNameAtBirth.$$warning}}
Voornaam vader
[ BDT ]
{{metaSection.forenameFather.$$error}}
{{metaSection.forenameFather.$$warning}}
Achternaam moeder bij de geboorte
[ BDT ]
{{metaSection.motherFamilyNameAtBirth.$$error}}
{{metaSection.motherFamilyNameAtBirth.$$warning}}
Voornaam moeder
[ BDT ]
{{metaSection.forenameMother.$$error}}
{{metaSection.forenameMother.$$warning}}
Aanvullende informatie over een persoon
*
[ SC ]
Status van de persoon
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.statusPerson.$$error}}
{{metaSection.statusPerson.$$warning}}
Gelieve in te vullen als "Status van de persoon" = "Andere":
[ SC ]
Andere status van de persoon
[ CDT ]
{{metaSection.otherStatusPerson.$$error}}
{{metaSection.otherStatusPerson.$$warning}}
Nationaliteit
[ ENUM ]
{{metaSection.nationality.$$error}}
{{metaSection.nationality.$$warning}}
Vroegere achternaam/-namen
[ SC ]
Vroegere achternaam/-namen
[ SC ]
Vroegere achternaam/-namen
[ BDT ]
{{metaSection.previousFamilyName.$$error}}
{{metaSection.previousFamilyName.$$warning}}
Vorige voornamen
[ SC ]
Vroegere voornaam
[ SC ]
Vroegere voornaam
[ BDT ]
{{metaSection.previousForename.$$error}}
{{metaSection.previousForename.$$warning}}
Huidige gezinssituatie
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.currentFamilyStatus.$$error}}
{{metaSection.currentFamilyStatus.$$warning}}
Datum van overlijden
[ BDT ]
{{metaSection.dateDeath.$$error}}
{{metaSection.dateDeath.$$warning}}
Is het verzoek binnen de termijn van 3 maanden ingediend?
*
[ SED ]
Is het verzoek binnen de termijn van 3 maanden ingediend?
*
{{option.name}}
[ ENUM ]
{{metaSection.requestHasBeenMadeWithin3MonthsPeriodIndicator.$$error}}
{{metaSection.requestHasBeenMadeWithin3MonthsPeriodIndicator.$$warning}}
Gelieve in te vullen indien "Is het verzoek binnen de termijn van 3 maanden ingediend?" = "Ja":
[ SED ]
Soort premies
[ SC ]
Soort premie
*
[ SC ]
Premie
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.contribution.$$error}}
{{metaSection.contribution.$$warning}}
Gelieve in te vullen als "Premie" = "Andere":
[ SC ]
Andere
[ CDT ]
{{metaSection.other.$$error}}
{{metaSection.other.$$warning}}
Premieperiode
*
[ CC ]
Vermeld de begindatum van de periode
*
[ BDT ]
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
Einddatum
*
[ BDT ]
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Premiebedrag
*
[ SC ]
Bedrag
*
[ BDT ]
{{metaSection.amount.$$error}}
{{metaSection.amount.$$warning}}
Munteenheid van het verzendende orgaan
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.currencySendingInstitution.$$error}}
{{metaSection.currencySendingInstitution.$$warning}}
Bedrag werkgeversdeel
[ BDT ]
{{metaSection.amountEmployerPart.$$error}}
{{metaSection.amountEmployerPart.$$warning}}
Bedrag verzekerdendeel
[ BDT ]
{{metaSection.amountInsuredPersonPart.$$error}}
{{metaSection.amountInsuredPersonPart.$$warning}}
Aanvullende informatie
[ SED ]
Bedrag van de voor terugbetaling in aanmerking komende premies wordt betaald:
[ SED ]
Bedrag voor bevoegd orgaan
[ PRIM ]
{{metaSection.amountForCompetentInstitution.$$error}}
{{metaSection.amountForCompetentInstitution.$$warning}}
Bedrag voor de persoon
[ PRIM ]
{{metaSection.amountForPerson.$$error}}
{{metaSection.amountForPerson.$$warning}}
Nadere informatie
[ CDT ]
{{metaSection.furtherInformation.$$error}}
{{metaSection.furtherInformation.$$warning}}
Terugbetaling is niet mogelijk
[ SED ]
Reden waarom terugbetaling niet mogelijk is.
[ CDT ]
{{metaSection.reasonWhyReimbursementNotPossible.$$error}}
{{metaSection.reasonWhyReimbursementNotPossible.$$warning}}
Vul dit onderdeel in als een ander orgaan bevoegd is:
[ SED ]
Bevoegde organen
[ SED ]
Bevoegd orgaan
[ CC ]
Identificatienummer van het orgaan
*
[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Naam orgaan
*
[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}