Pretensjoni għal rimborż (CLA)

S080 - Pretensjoni għal rimborż (CLA)
L-Artikoli 62, 66(1), 67 tar-Regolament (KE) Nru 987/2009

SED API version: 0.16.2 build 2
Model version: 4.2.0

Nota Globali CLA * [ SED ]

Referenza CLA Globali tal-Korp ta' Kollegament Kreditur *

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Għadd totali ta' pretensjonijiet individwali *

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Ammont totali ta’ benefiċċji * [ CC ]

Ammont *

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Munita *

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Numru ta’ Nofs is-Sena fl-Istituzzjoni Kreditriċi *

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Numru tas-sena finanzjarja fl-istituzzjoni kreditriċi *

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Kont bankarju tal-Korp ta' Kollegament Kreditur * [ CC ]

IBAN *

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BIC-SWIFT

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Data għas-sottomissjoni *

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CLAs Individwali * [ SED ]

CLA individwali * [ SED ]

ID tal-Istituzzjoni Kreditriċi * [ CC ]

ID tal-istituzzjoni *

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Isem l-istituzzjoni *

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ID tal-Istituzzjoni Debitriċi * [ CC ]

ID tal-istituzzjoni *

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Isem l-istituzzjoni *

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Referenzi * [ SED ]

Referenza CLA Globali tal-Korp ta' Kollegament Kreditur *

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Numru CLA individwali tal-Korp ta' Kollegament Kreditur *

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Data meta l-Istituzzjoni Kreditriċi Rreġistrat CLA *

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Persuna li tirċievi benefiċċji * [ CC ]

Tagħrif dwar il-Persuna * [ CC ]

Kunjom(ijiet) *

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Isem/ismijiet *

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Data tat-twelid *

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Sess *

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Kunjom(ijiet) tat-twelid

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Isem/ismijiet tat-twelid

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Numru tal-Identifikazzjoni Personali * [ CC ]

PIN tal-persuna fl-Istat Membru Kompetenti *

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PIN tal-persuna fl-Istat Membru tas-Soġġorn jew tar-Residenza

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Dokument tal-intitolament * [ SED ]

Dokument *

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Jekk jogħġbok imla dan li ġej jekk "Dokument ta’ intitolament" = "01 - EHIC - Karta tal-Assikurazzjoni tas-Saħħa tal-Unjoni Ewropea” : [ SED ]

Jekk jogħġbok imla dan li ġej jekk "Dokument tad-Dritt" = "02 - PRC Ċertifikat Provviżorju ta’ Sostituzzjoni", "04 - S2 Dritt għal kura skedata", "08 - S045 Dokument tad-dritt - Soġġorn Temporanju" jew "12 - E112 Ċertifikat dwar iż-żamma tad-dritt għall-benefiċċji tal-mard jew tal-maternità” : [ SED ]

Jekk jogħġbok imla dan li ġej jekk "Dokument tad-Dritt" <> "01 - EHIC - Karta tal-Assikurazzjoni tas-Saħħa tal-Unjoni Ewropea”, "02 - PRC Ċertifikat Provviżorju ta’ Sostituzzjoni", "04 - S2 Dritt għal kura skedata", "08 - S045 Dokument tad-dritt - Soġġorn Temporanju" jew "12 - E112 Ċertifikat dwar iż-żamma tad-dritt għall-benefiċċji tal-mard jew tal-maternità” : [ SED ]

Numru tal-EHIC *

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Perjodu ta’ validità tad-dritt * [ CC ]

Data tal-bidu

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Data tat-tmiem *

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Perjodu ta’ validità tad-dritt * [ CC ]

Data tal-bidu *

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Data tat-tmiem *

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Data tal-ħruġ *

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Perjodu ta’ validità tad-dritt * [ CC ]

Perjodu Fiss * [ CC ]

Perjodu Miftuħ * [ CC ]

Data tal-bidu *

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Data tat-tmiem *

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Tip ta’ Perjodu Miftuħ *

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Data tal-bidu *

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Data tal-ħruġ *

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Ammont individwali totali tal-benefiċċji * [ CC ]

Ammont *

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Munita *

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Benefiċċji offruti * [ SC ]

Natura tal-benefiċċji *

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Perjodu tal-benefiċċji * [ CC ]

Data tal-bidu *

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Data tat-tmiem *

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Ammont Kollu tal-Benefiċċji * [ SC ]

Ammont ta' kura medika

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Ammont tal-mediċina

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Ammont ta' kura tas-snien

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Ammont għall-Kura fit-Tul

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Benefiċċji ta’ Kura fi Sptar [ SC ]

Benefiċċju għal kura fi sptar [ SC ]

Perjodu ta’ kura fl-isptar [ CC ]

Data tal-bidu *

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Data tat-tmiem *

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Ammont tal-kura fl-isptar *

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Benefiċċju għal kura fi sptar

Benefiċċju/i ieħor/oħrajn [ SC ]

Benefiċċju ieħor [ SC ]

Deskrizzjoni ta’ Benefiċċju Ieħor *

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Ammont ta' benefiċċji oħra *

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Benefiċċju ieħor

CLA individwali

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S080 - Pretensjoni għal rimborż (CLA) L-Artikoli 62, 66(1), 67 tar-Regolament (KE) Nru 987/2009

S080 - Pretensjoni għal rimborż (CLA)
L-Artikoli 62, 66(1), 67 tar-Regolament (KE) Nru 987/2009