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<AOAT503 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="AOAT503_20262.xsd">
	<Form>
		<Identification>AOAT503</Identification>
		<FormCreationDate>2022-08-11</FormCreationDate>
		<FormCreationHour>09:20:58.082</FormCreationHour>
		<AttestationStatus>0</AttestationStatus>
		<TypeForm>SU</TypeForm>
		<HandledOriginalForm>
			<Identification>AOAT003</Identification>
			<FormCreationDate>2003-11-05</FormCreationDate>
			<FormCreationHour>15:46:21.045</FormCreationHour>
			<AttestationStatus>0</AttestationStatus>
			<TypeForm>SU</TypeForm>
		</HandledOriginalForm>
		<DclInformation>
			<LanguageCodePdf>1</LanguageCodePdf>
		</DclInformation>
		<Reference>
			<ReferenceType>4</ReferenceType>
			<ReferenceOrigin>2</ReferenceOrigin>
			<ReferenceNbr>3400001EY901D</ReferenceNbr>
		</Reference>
		<Reference>
			<ReferenceType>2</ReferenceType>
			<ReferenceOrigin>2</ReferenceOrigin>
			<ReferenceNbr>XXXYYYZZZ</ReferenceNbr>
		</Reference>
		<HandledReference>
			<ReferenceType>1</ReferenceType>
			<ReferenceOrigin>2</ReferenceOrigin>
			<ReferenceNbr>3400000MYY01H</ReferenceNbr>
		</HandledReference>
		<EmployerDeclarationLink>
			<NOSSRegistrationNbr>141137377</NOSSRegistrationNbr>
			<Trusteeship>0</Trusteeship>
			<CompanyID>1111111111</CompanyID>
			<HandledEmployerDeclarationLink>
				<NOSSRegistrationNbr>141137377</NOSSRegistrationNbr>
				<Trusteeship>0</Trusteeship>
				<CompanyID>1111111111</CompanyID>
				<EmployerDenomination>Lekkere Bakker</EmployerDenomination>
				<EmployerStreet>Kolonel Dussartplein</EmployerStreet>
				<EmployerHouseNbr>44</EmployerHouseNbr>
				<EmployerZIPCode>3600</EmployerZIPCode>
				<EmployerCity>Genk</EmployerCity>
				<EmployerCountry>150</EmployerCountry>
				<ImportanceCode>5</ImportanceCode>
			</HandledEmployerDeclarationLink>
			<NaturalPerson>
				<NaturalPersonSequenceNbr>1</NaturalPersonSequenceNbr>
				<INSS>57040610511</INSS>
				<HandledNaturalPerson>
					<NaturalPersonSequenceNbr>1</NaturalPersonSequenceNbr>
					<INSS>57040610511</INSS>
					<WorkerName>Dulière</WorkerName>
					<WorkerFirstName>Michel</WorkerFirstName>
					<WorkerBirthdate>1957-04-06</WorkerBirthdate>
					<WorkerSex>1</WorkerSex>
					<Nationality>111</Nationality>
					<OriolusSuccessCode>1</OriolusSuccessCode>
					<OriolusSubStatusRip>0</OriolusSubStatusRip>
					<BisFlagIndication>0</BisFlagIndication>
				</HandledNaturalPerson>
				<WorkRecovery>
					<WorkRecoveryDate>2003-10-01</WorkRecoveryDate>
				</WorkRecovery>
				<InsuranceLink>
					<InsurerId>1018</InsurerId>
					<PolicyIdentifier>123456789</PolicyIdentifier>
				</InsuranceLink>
				<AccidentLink>
					<AccidentDate>2003-09-14</AccidentDate>
				</AccidentLink>
			</NaturalPerson>
		</EmployerDeclarationLink>
	</Form>
</AOAT503>