Verzoek om terugbetaling

U020 - Verzoek om terugbetaling
Artikel 65, leden 6 en 7, van Verordening (EG) nr. 883/2004; artikel 70 van Verordening (EG) No 987/2009

SED API version: 0.16.2 build 2
Model version: 4.2.0

Lokale dossiernummers [ CC ]

Lokaal dossiernummer [ CC ]

Land *

[ 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}}

Lokaal dossiernummer

Algemene informatie * [ SED ]

ID verzoek om terugbetaling *

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

Totaal aantal individuele vorderingen *

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

Gevraagde totaalbedrag * [ CC ]

Bedrag *

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

Munteenheid *

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

Bankgegevens * [ SC ]

SEPA-bankgegevens * [ CC ]

IBAN *

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

BIC-SWIFT

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

Bankoverschrijving: onderwerp of transactiereferentie *

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

Individuele vorderingen * [ SED ]

Individuele vordering * [ SED ]

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 *

[ 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 *

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

Persoonlijk identificatienummer (PIN) *

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

Sector

[ 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}}

Persoonlijk(e) identificatienummer(s)

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 *

[ 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 betreffende de persoon [ SC ]

Nationaliteit

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

ID verzoek om terugbetaling *

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

Volgnummer individuele vordering *

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

Orgaan dat verzekeringsloopbaan heeft bevestigd * [ CC ]

Identificatienummer van het orgaan *

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

Naam orgaan *

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

In aanmerking genomen perioden van werk * [ SED ]

In aanmerking genomen periode van werk * [ CC ]

Vermeld de begindatum van de periode *

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

Einddatum *

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

In aanmerking genomen periode van werk

Periode van terugbetaling * [ CC ]

Vermeld de begindatum van de periode *

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

Einddatum *

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

Datum laatste betaling *

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

Teruggevraagd bedrag * [ CC ]

Bedrag *

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

Munteenheid *

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

Individuele vordering

{{ row.severityMessage }} : {{ row.message }}

U020 - Verzoek om terugbetaling Artikel 65, leden 6 en 7, van Verordening (EG) nr. 883/2004; artikel 70 van Verordening (EG) No 987/2009

U020 - Verzoek om terugbetaling
Artikel 65, leden 6 en 7, van Verordening (EG) nr. 883/2004; artikel 70 van Verordening (EG) No 987/2009