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		<ns0:Identification>LOIC501</ns0:Identification>
		<ns0:FormCreationDate>2022-10-01</ns0:FormCreationDate>
		<ns0:FormCreationHour>14:01:00.000</ns0:FormCreationHour>
		<ns0:AttestationStatus>0</ns0:AttestationStatus>
		<ns0:TypeForm>SU</ns0:TypeForm>
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			<ns0:ReferenceNbr>0340SSLOIC501</ns0:ReferenceNbr>
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		<ns0:Reference>
			<ns0:ReferenceType>4</ns0:ReferenceType>
			<ns0:ReferenceOrigin>1</ns0:ReferenceOrigin>
			<ns0:ReferenceNbr>MyReferenceLOIC001</ns0:ReferenceNbr>
		</ns0:Reference>
		<ns0:Reference>
			<ns0:ReferenceType>4</ns0:ReferenceType>
			<ns0:ReferenceOrigin>2</ns0:ReferenceOrigin>
			<ns0:ReferenceNbr>0340SSLOIC001</ns0:ReferenceNbr>
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			<ns0:SenderId>001821</ns0:SenderId>
			<ns0:FileReference>
				<ns0:FileName>GO.LOIC.001821.20200216.90002.R.1</ns0:FileName>
				<ns0:ReferenceOrigin>2</ns0:ReferenceOrigin>
				<ns0:ReferenceNbr>0380048EJ3JGZ</ns0:ReferenceNbr>
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				<ns0:ReceptionDate>2022-10-01</ns0:ReceptionDate>
				<ns0:ReceptionHour>12:16:43.000</ns0:ReceptionHour>
				<ns0:Channel>0</ns0:Channel>
			</ns0:FileReceptionInformation>
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		<ns0:ReferenceData>
			<ns0:INSS>94081900133</ns0:INSS>
			<ns0:EmployerId>
				<ns0:NOSSRegistrationNbr>123456799</ns0:NOSSRegistrationNbr>
				<ns0:CompanyID>0123456789</ns0:CompanyID>
				<ns0:HandledEmployerId>
					<ns0:EmployerDenomination>Ma petite entreprise</ns0:EmployerDenomination>
					<ns0:EmployerStreet>Avenue du Paradis</ns0:EmployerStreet>
					<ns0:EmployerHouseNbr>7</ns0:EmployerHouseNbr>
					<ns0:EmployerPostBox>a</ns0:EmployerPostBox>
					<ns0:EmployerZIPCode>1000</ns0:EmployerZIPCode>
					<ns0:EmployerCity>Bruxelles</ns0:EmployerCity>
					<ns0:EmployerCountry>150</ns0:EmployerCountry>
					<ns0:ImportanceCode>1</ns0:ImportanceCode>
					<ns0:LegalForm>ASBL</ns0:LegalForm>
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				<ns0:TechnicalDescription>
					<ns0:MimeType>application/xml</ns0:MimeType>
					<ns0:CharacterFormat>NATIVE</ns0:CharacterFormat>
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			<ns0:DocumentXML>
				<ns2:LOIC501 xsi:schemaLocation="http://socialsecurity.be/xml/ns/loic LOIC501_20262.xsd">
					<ns2:CoordinatesInformant>
						<ns2:UserQuality>11</ns2:UserQuality>
						<ns2:Denomination>Ma petite entreprise</ns2:Denomination>
					</ns2:CoordinatesInformant>
					<ns2:HandledNaturalPerson>
						<ns2:NaturalPersonSequenceNbr>1</ns2:NaturalPersonSequenceNbr>
						<ns2:INSS>94081900124</ns2:INSS>
						<ns2:WorkerName>Thiam</ns2:WorkerName>
						<ns2:WorkerFirstName>Nafissatou</ns2:WorkerFirstName>
						<ns2:WorkerBirthdate>1994-08-19</ns2:WorkerBirthdate>
						<ns2:WorkerSex>2</ns2:WorkerSex>
					</ns2:HandledNaturalPerson>
					<ns2:DclInformation>
						<ns2:LanguageCodePdf>1</ns2:LanguageCodePdf>
					</ns2:DclInformation>
					<ns2:CoordinatesContactPerson>
						<ns2:Name>Adam</ns2:Name>
						<ns2:FirstName>Eve</ns2:FirstName>
						<ns2:Address>
							<ns2:Street>Avenue du Paradis</ns2:Street>
							<ns2:HouseNbr>7</ns2:HouseNbr>
							<ns2:PostBox>a</ns2:PostBox>
							<ns2:ZIPCode>1000</ns2:ZIPCode>
							<ns2:City>Bruxelles</ns2:City>
							<ns2:Country>150</ns2:Country>
						</ns2:Address>
						<ns2:Communication>
							<ns2:PhoneNbr>027635711</ns2:PhoneNbr>
							<ns2:GSMNbr>0479312300</ns2:GSMNbr>
							<ns2:FaxNbr>027635711</ns2:FaxNbr>
							<ns2:EmailAddress>HRDepartment@MaPetiteEntreprise.be</ns2:EmailAddress>
						</ns2:Communication>
					</ns2:CoordinatesContactPerson>
					<ns2:WorkerContactDetails>
						<ns2:EmailAddress>Loic.Worker@rva.be</ns2:EmailAddress>
					</ns2:WorkerContactDetails>
					<ns2:InterruptionInformation>
						<ns2:StartingDate>2022-10-01</ns2:StartingDate>
						<ns2:EndingDate>2023-09-30</ns2:EndingDate>
						<ns2:InterruptionType>5100</ns2:InterruptionType>
						<ns2:InterruptionRegime>5</ns2:InterruptionRegime>
						<ns2:LegalBasis>9</ns2:LegalBasis>
						<ns2:MeanWorkingHours>3800</ns2:MeanWorkingHours>
						<ns2:RefMeanWorkingHours>3800</ns2:RefMeanWorkingHours>
						<ns2:JointCommissionNbr>200</ns2:JointCommissionNbr>
						<ns2:WeekHoursNbr>3040</ns2:WeekHoursNbr>
						<ns2:WorkingSystemType>V</ns2:WorkingSystemType>
						<ns2:Duration>1</ns2:Duration>
						<ns2:TimeUnit>4</ns2:TimeUnit>
						<ns2:HandledServiceData>
							<ns2:DimonaNbr>12345678</ns2:DimonaNbr>
						</ns2:HandledServiceData>
					</ns2:InterruptionInformation>
					<ns2:EmployerInterruptionForm>
						<ns2:DocumentDate>2022-09-15</ns2:DocumentDate>
						<ns2:InterruptionSectorCode>1A</ns2:InterruptionSectorCode>
						<ns2:Questionnaire>
							<ns2:InterruptionQuestion>
								<ns2:InterruptionQuestionCode>QR01</ns2:InterruptionQuestionCode>
								<ns2:InterruptionQuestionAnswer>1</ns2:InterruptionQuestionAnswer>
							</ns2:InterruptionQuestion>
							<ns2:InterruptionQuestion>
								<ns2:InterruptionQuestionCode>QR04</ns2:InterruptionQuestionCode>
								<ns2:InterruptionQuestionAnswer>1</ns2:InterruptionQuestionAnswer>
							</ns2:InterruptionQuestion>
							<ns2:InterruptionQuestion>
								<ns2:InterruptionQuestionCode>QR06</ns2:InterruptionQuestionCode>
								<ns2:InterruptionQuestionAnswer>1</ns2:InterruptionQuestionAnswer>
							</ns2:InterruptionQuestion>
							<ns2:InterruptionQuestion>
								<ns2:InterruptionQuestionCode>QR08</ns2:InterruptionQuestionCode>
								<ns2:InterruptionQuestionAnswer>0</ns2:InterruptionQuestionAnswer>
							</ns2:InterruptionQuestion>
							<ns2:InterruptionQuestion>
								<ns2:InterruptionQuestionCode>QR09</ns2:InterruptionQuestionCode>
								<ns2:InterruptionQuestionAnswer>0</ns2:InterruptionQuestionAnswer>
							</ns2:InterruptionQuestion>
							<ns2:InterruptionQuestion>
								<ns2:InterruptionQuestionCode>QR13</ns2:InterruptionQuestionCode>
								<ns2:InterruptionQuestionAnswer>0</ns2:InterruptionQuestionAnswer>
							</ns2:InterruptionQuestion>
							<ns2:InterruptionQuestion>
								<ns2:InterruptionQuestionCode>QR14</ns2:InterruptionQuestionCode>
								<ns2:InterruptionQuestionAnswer>1</ns2:InterruptionQuestionAnswer>
							</ns2:InterruptionQuestion>
						</ns2:Questionnaire>
						<ns2:CollectiveLabourAgreement>
							<ns2:CLACode>CLA103</ns2:CLACode>
						</ns2:CollectiveLabourAgreement>
					</ns2:EmployerInterruptionForm>
					<ns2:CommentDeclaration>
						<ns2:CommentOfDeclaration>Ceci est une demande fictive d'interruption de carrière</ns2:CommentOfDeclaration>
					</ns2:CommentDeclaration>
				</ns2:LOIC501>
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		</ns0:Data>
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