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Name - Always enter the names of all claimants and in survivor cases, the name of
the deceased worker.
Enter the first name, middle and last names and if applicable, the maiden name. For
Portuguese citizens, show the complete name in the order shown on the Portuguese identity
card or passport.
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Date of Birth - Enter the date of birth for all claimants and for the deceased worker.
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Verified - (Completed only by OIO) Check this block if:
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the date of birth has been used to award U.S. benefits, or the date of birth is shown
on the MBR as proven.
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Monthly Benefit and Effective Date - (Completed only by OIO) Complete these blocks
when benefits have been awarded if:
A claim for Portuguese benefits is or has been transmitted, or a Portuguese agency
has requested the information.
For retirement or disability claims, enter the MBC for the worker and spouse effective
with the first month of entitlement or August 1989, whichever is later.
For survivor claims, enter the MBC for the deceased worker effective with the month
prior to the month of death. Enter the MBC for the widow and surviving children effective
with the first month of entitlement for survivor benefits or August 1, 1989, whichever
is later.
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Date of death, marriage and divorce - Complete these items only if transmitting a
claim for Portuguese benefits, or responding to a Portuguese agency request.
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“Verified” - (Completed only by OIO) Check this block if the data has been used to award U.S.
benefits, or the data is shown on the MBR as proven.