TN 1 (02-95)
GN 01724.235 Facts About the French Liaison Form SE 404-03
A. When to use form SE 404-03
France uses Form SE 404-03 to:
transmit claims and related material to DIO.
send information requested by DIO to us, and
request information from DIO.
B. Description of the SE 404-03
Form SE 404-03 is identical to the SSA-e2960 U3-FR in the order of the information blocks and the wording of each block. However, the layout of the blocks differ. The SE 404-03 is bilingual and printed on more than one page.
C. Exhibit — SE 404-03
The following is an exhibit of Page 1 of the SE 404-03 (USA/France Liaison Form).
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