TN 1 (02-95)
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.
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.
The following is an exhibit of Page 1 of the SE 404-03 (USA/France Liaison Form).