Reply to request for arrears

R006 - Reply to request for arrears
Article 72(2) 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.Person

3. Information that there are arrears *

3.1. Information that there are arrears *

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3.2. Please fill in the following if "Information that there are arrears" = "Yes" :

3.2.1. Entitlement to corresponding benefit *

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3.2.2. Please fill in the following if "Entitlement to corresponding benefit" = "Yes" :

3.2.2.1. Arrears have already been paid out *

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3.2.2.2. Please fill in the following if "Arrears have already been paid out" = "No" :

3.2.2.2.1. Arrears details

3.2.2.2.1.1. Arrears period

3.2.2.2.1.1.1. Start Date *

3.2.2.2.1.1.2. End Date *

3.2.2.2.1.2. Arrears total amount

3.2.2.2.1.2.1. Amount *

3.2.2.2.1.2.2. Currency *

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R006 - Reply to request for arrears Article 72(2) of Regulation (EC) No 987/2009

R006 - Reply to request for arrears
Article 72(2) of Regulation (EC) No 987/2009