Vidarebefordra ärende

X007 - Vidarebefordra ärende

SED API version: 0.16.2 build 2
Model version: 4.2.0

Ärendeuppgifter * [ SC ]

Personuppgifter * [ CC ]

Arbetsgivaruppgifter * [ CC ]

Uppgifter om återbetalning * [ SC ]

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 *

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

Namn *

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

identifikationsnummer [ CC ]

Identifieringsnummer [ CC ]

Nummer *

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

Typ *

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

Identifieringsnummer

Adress [ CC ]

Gatuadress

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

Byggnadens namn

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

Ort *

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

Postnummer

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

Region

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

Land *

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

ID för begäran om återbetalning *

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

Totalt antal enskilda fordringar *

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

Vidarebefordra uppgifter * [ SED ]

Tillagd deltagare * [ CC ]

Institutionens ID *

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

Institutionens namn *

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

Borttagen deltagare * [ CC ]

Institutionens ID *

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

Institutionens namn *

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

Skäl

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

Vänligen lämna information om "99 - övrigt" har valts

[ CDT ] {{metaSection.pleaseProvideMoreDetailsIf99OtherSelected.$$error}} {{metaSection.pleaseProvideMoreDetailsIf99OtherSelected.$$warning}}

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