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Get DP 202H - Anmodning Om Lnrefusion Ressourceforlbsydelse Under Jobafklaringsforlb 032015 100315-23

Avn og adresse Identifikation Medarbejderens personnummer CVR-nummer P-nummer/SE-nummer F rste sygefrav rsdag dato 1. Medarbejderens l nforhold Har medarbejderen genoptaget arbejdet Nej Ja, fuldt Ja, delvist Ja, delvist og fuldt Forts ttes l nudbetalingen Nej Ja Er der sket ndringer i den aktuelle l n i refusionsperioden Nej Ja Dato for sidste sygefrav rsdag Oplys dato for delvis genoptagelse af arbejdet og udfyld punkt 3 Hvis nej, oplys sidste dag med udbetaling Hvis.

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