Notification of payment

R004 - Notification of payment
Articles 37(2), 72, 73, 78, 80 and 85 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. Concerns *

2.1. Concerns *

Please fill in the following if "Concerns" = "Person" :
Please fill in the following if "Concerns" = "Employer" :

3.1. Persons

3.1.1. Person *

3.1.1.1. Person Identification *

3.1.1.1.1. Family name(s) *

3.1.1.1.2. Forename(s) *

3.1.1.1.3. Date of birth *

3.1.1.1.4. Sex *

3.1.1.1.5. Family name(s) at birth

3.1.1.1.6. Forename(s) at birth

3.1.1.1.7. PIN of the person in each institution

3.1.1.1.7.1. Personal Identification Number(s) *

3.1.1.1.7.1.1. Country *

3.1.1.1.7.1.2. Personal Identification Number (PIN) *

3.1.1.1.7.1.3. Sector

3.1.1.1.7.1.4. Institution

3.1.1.1.7.1.4.1. Institution ID *

3.1.1.1.7.1.4.2. Institution Name *

3.1.1.1.7.1.Personal Identification Number(s)

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

3.1.1.1.8.1. Place of birth

3.1.1.1.8.1.1. Town *

3.1.1.1.8.1.2. Region

3.1.1.1.8.1.3. Country *

3.1.1.1.8.2. Father's family name at birth

3.1.1.1.8.3. Forename of father

3.1.1.1.8.4. Mother's family name at birth

3.1.1.1.8.5. Forename of mother

3.1.1.2. Additional information about a person *

3.1.1.2.1. Status of the person *

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

3.1.1.2.2.1. Other status of the person

3.1.1.2.3. Nationality

3.1.1.2.4. Previous family name(s)

3.1.1.2.4.1. Previous family name(s)

3.1.1.2.4.1.1. Previous family name(s)

3.1.1.2.4.1.Previous family name(s)

3.1.1.2.5. Previous forenames

3.1.1.2.5.1. Previous forename

3.1.1.2.5.1.1. Previous forename

3.1.1.2.5.1.Previous forename

3.1.1.2.6. Current family status

3.1.1.2.7. Date of death

3.1.1.Person

4.1. Employer *

4.1.1. Name *

4.1.2. Identification numbers

4.1.2.1. Identification number

4.1.2.1.1. Number *

4.1.2.1.2. Type *

4.1.2.1.Identification number

4.1.3. Address

4.1.3.1. Street

4.1.3.2. Building Name

4.1.3.3. Town *

4.1.3.4. Postal Code

4.1.3.5. Region

4.1.3.6. Country *

4.2. Responsible person or section

4.2.1. Responsible person or section

4.2.2. Contact Information

4.2.2.1. Telephone Numbers

4.2.2.1.1. Telephone Number

4.2.2.1.1.1. Type

4.2.2.1.1.2. Number *

4.2.2.1.1.Telephone Number

4.2.2.2. Email Addresses

4.2.2.2.1. Email Address

4.2.2.2.1.1. Email Address

4.2.2.2.1.Email Address

4.3. Persons

4.3.1. Person *

4.3.1.1. Person Identification *

4.3.1.1.1. Family name(s) *

4.3.1.1.2. Forename(s) *

4.3.1.1.3. Date of birth *

4.3.1.1.4. Sex *

4.3.1.1.5. Family name(s) at birth

4.3.1.1.6. Forename(s) at birth

4.3.1.1.7. PIN of the person in each institution

4.3.1.1.7.1. Personal Identification Number(s) *

4.3.1.1.7.1.1. Country *

4.3.1.1.7.1.2. Personal Identification Number (PIN) *

4.3.1.1.7.1.3. Sector

4.3.1.1.7.1.4. Institution

4.3.1.1.7.1.4.1. Institution ID *

4.3.1.1.7.1.4.2. Institution Name *

4.3.1.1.7.1.Personal Identification Number(s)

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

4.3.1.1.8.1. Place of birth

4.3.1.1.8.1.1. Town *

4.3.1.1.8.1.2. Region

4.3.1.1.8.1.3. Country *

4.3.1.1.8.2. Father's family name at birth

4.3.1.1.8.3. Forename of father

4.3.1.1.8.4. Mother's family name at birth

4.3.1.1.8.5. Forename of mother

4.3.1.2. Additional information about a person *

4.3.1.2.1. Status of the person *

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

4.3.1.2.2.1. Other status of the person

4.3.1.2.3. Nationality

4.3.1.2.4. Previous family name(s)

4.3.1.2.4.1. Previous family name(s)

4.3.1.2.4.1.1. Previous family name(s)

4.3.1.2.4.1.Previous family name(s)

4.3.1.2.5. Previous forenames

4.3.1.2.5.1. Previous forename

4.3.1.2.5.1.1. Previous forename

4.3.1.2.5.1.Previous forename

4.3.1.2.6. Current family status

4.3.1.2.7. Date of death

4.3.1.Person

5. Payments *

5.1. Payment *

5.1.1. Reason for payment *

5.1.2. Payment details

5.1.2.1. Type of payment *

5.1.2.2. Payment date *

5.1.2.3. Amount *

5.1.2.3.1. Amount *

5.1.2.3.2. Currency *

5.1.3. Payment reference to be used when transferring money *

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5.1.Payment

6. Additional information

6.1. Additional information

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R004 - Notification of payment Articles 37(2), 72, 73, 78, 80 and 85 of Regulation (EC) No 987/2009

R004 - Notification of payment
Articles 37(2), 72, 73, 78, 80 and 85 of Regulation (EC) No 987/2009