Request for deductions from arrears/ongoing payments

R001 - Request for deductions from arrears/ongoing payments
Article 72(1) of Regulation (EC) No 987/2009

SED API version: 0.14.2 PREVIEW build 3
Model version: 4.0.16

1. Local case numbers

1.1. Local Case Number

1.1.1. Country *

1.1.2. Case number *

1.1.3. Institution

1.1.3.1. Institution ID *

1.1.3.2. Institution Name *

1.1.Local Case Number

2. Persons *

2.1. Person *

2.1.1. Person Identification *

2.1.1.1. Family name(s) *

2.1.1.2. Forename(s) *

2.1.1.3. Date of birth *

2.1.1.4. Sex *

2.1.1.5. Family name(s) at birth

2.1.1.6. Forename(s) at birth

2.1.1.7. PIN of the person in each institution

2.1.1.7.1. Personal Identification Number(s) *

2.1.1.7.1.1. Country *

2.1.1.7.1.2. Personal Identification Number (PIN) *

2.1.1.7.1.3. Sector

2.1.1.7.1.4. Institution

2.1.1.7.1.4.1. Institution ID *

2.1.1.7.1.4.2. Institution Name *

2.1.1.7.1.Personal Identification Number(s)

2.1.1.8. If PIN not provided for every institution, please provide

2.1.1.8.1. Place of birth

2.1.1.8.1.1. Town *

2.1.1.8.1.2. Region

2.1.1.8.1.3. Country *

2.1.1.8.2. Father's family name at birth

2.1.1.8.3. Forename of father

2.1.1.8.4. Mother's family name at birth

2.1.1.8.5. Forename of mother

2.1.2. Additional information about a person *

2.1.2.1. Status of the person *

2.1.2.2. Please fill in the following if "Status of the person" = "Other" :

2.1.2.2.1. Other status of the person

2.1.2.3. Nationality

2.1.2.4. Previous family name(s)

2.1.2.4.1. Previous family name(s)

2.1.2.4.1.1. Previous family name(s)

2.1.2.4.1.Previous family name(s)

2.1.2.5. Previous forenames

2.1.2.5.1. Previous forename

2.1.2.5.1.1. Previous forename

2.1.2.5.1.Previous forename

2.1.2.6. Current family status

2.1.2.7. Date of death

2.1.3. Person's last known addresses

2.1.3.1. Person's last known address details *

2.1.3.1.1. Type of address *

2.1.3.1.2. Please fill in the following if "Type of address" = "Other" :

2.1.3.1.2.1. Specify "Other" Type

2.1.3.1.3. Address detail *

2.1.3.1.3.1. Street

2.1.3.1.3.2. Building Name

2.1.3.1.3.3. Town *

2.1.3.1.3.4. Postal Code

2.1.3.1.3.5. Region

2.1.3.1.3.6. Country *

2.1.3.1.Person's last known address details

2.1.Person

3. Type of request *

3.1. Type of request *

4. Benefits received unduly *

4.1. Type of benefit

4.2. Please fill in the following if "Type of benefit" = "Other benefit" :

4.2.1. Type of other benefits

5. Please fill in the following if "Type of request" = "Final" :

5.1. Overpayment periods

5.1.1. Overpayment period

5.1.1.1. Period

5.1.1.1.1. Start Date *

5.1.1.1.2. End Date *

5.1.1.2. Date of decision

5.1.1.3. Reason for overpayment *

5.1.1.4. Please fill in the following if "Reason for overpayment" = "Other"

5.1.1.4.1. Other reason

5.1.1.Overpayment period

5.2. Payment amount

5.2.1. Overpaid amount for whole period *

5.2.1.1. Amount *

5.2.1.2. Currency *

5.2.2. Detailed information about overpaid amounts

5.2.2.1. Detailed information about overpaid amount

5.2.2.1.1. Start date *

5.2.2.1.2. Details

5.2.2.1.2.1. Frequency *

5.2.2.1.2.2. Please fill in the following if "Frequency" = "Other" :

5.2.2.1.2.2.1. Other frequency

5.2.2.1.2.3. Number of periodic units *

5.2.2.1.2.4. Amount per unit *

5.2.2.1.2.4.1. Amount *

5.2.2.1.2.4.2. Currency *

5.2.2.1.Detailed information about overpaid amount

5.3. Benefit deduction

5.3.1. Type of benefit

5.3.2. Please fill in the following if "Type of benefit" = "Other benefit" :

5.3.2.1. Type of other benefits

5.4. Deduction from arrears

5.4.1. Deduction from arrears possible *

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5.4.2. Please fill in the following if "Deduction from arrears possible" = "Yes" :

5.4.2.1. Detailed information about deductions from arrears

5.4.2.1.1. Detailed information about deduction from arrears

5.4.2.1.1.1. Start date

5.4.2.1.1.2. Details

5.4.2.1.1.2.1. Frequency *

5.4.2.1.1.2.2. Please fill in the following if "Frequency" = "Other" :

5.4.2.1.1.2.2.1. Other frequency

5.4.2.1.1.2.3. Number of periodic units *

5.4.2.1.1.2.4. Amount per unit *

5.4.2.1.1.2.4.1. Amount *

5.4.2.1.1.2.4.2. Currency *

5.4.2.1.1.Detailed information about deduction from arrears

5.5. Deduction from ongoing payments

5.5.1. Deduction in general possible *

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5.5.2. Detailed information about deduction from ongoing payments

5.5.2.1. Frequency *

5.5.2.2. Please fill in the following if "Frequency" = "Other" :

5.5.2.2.1. Other frequency

5.5.2.3. Number of periodic units *

5.5.2.4. Amount per unit *

5.5.2.4.1. Amount *

5.5.2.4.2. Currency *

6. Additional information

6.1. Additional information

7. Please fill in the following if "Type of request" = "Final" :

7.1. Bank details

7.1.1. SEPA Bank details *

7.1.1.1. IBAN *

7.1.1.2. BIC-SWIFT

7.1.2. Account holder name *

7.1.3. Payment reference *

7.1.4. Receiving bank address

7.1.4.1. Street

7.1.4.2. Building Name

7.1.4.3. Town *

7.1.4.4. Postal Code

7.1.4.5. Region

7.1.4.6. Country *

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R001 - Request for deductions from arrears/ongoing payments Article 72(1) of Regulation (EC) No 987/2009

R001 - Request for deductions from arrears/ongoing payments
Article 72(1) of Regulation (EC) No 987/2009