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		<Identification>LOIC001</Identification>
		<FormCreationDate>2022-08-10</FormCreationDate>
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				<NOSSRegistrationNbr>175110995</NOSSRegistrationNbr>
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				<loic:LOIC001 xsi:schemaLocation="http://socialsecurity.be/xml/ns/loic LOIC001_20254.xsd" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:loic="http://socialsecurity.be/xml/ns/loic">
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					<loic:CoordinatesContactPerson>
						<loic:Name>Gyssels</loic:Name>
						<loic:FirstName>Philip</loic:FirstName>
						<loic:Address>
							<loic:Street>Keizerslaan</loic:Street>
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							<loic:PostBox>a</loic:PostBox>
							<loic:ZIPCode>1000</loic:ZIPCode>
							<loic:City>Bruxelles</loic:City>
							<loic:Country>150</loic:Country>
						</loic:Address>
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							<loic:PhoneNbr>025154207</loic:PhoneNbr>
							<loic:GSMNbr>0478361562</loic:GSMNbr>
							<loic:FaxNbr>027635711</loic:FaxNbr>
							<loic:EmailAddress>philip.gyssels@rva.be</loic:EmailAddress>
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					<loic:WorkerContactDetails>
						<loic:EmailAddress>Loic.Worker@rva.be</loic:EmailAddress>
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						<loic:StartingDate>2022-10-01</loic:StartingDate>
						<loic:EndingDate>2023-09-30</loic:EndingDate>
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						<loic:DocumentDate>2022-09-15</loic:DocumentDate>
						<loic:InterruptionSectorCode>1A</loic:InterruptionSectorCode>
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								<loic:InterruptionQuestionCode>QR01</loic:InterruptionQuestionCode>
								<loic:InterruptionQuestionAnswer>1</loic:InterruptionQuestionAnswer>
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								<loic:InterruptionQuestionAnswer>1</loic:InterruptionQuestionAnswer>
							</loic:InterruptionQuestion>
							<loic:InterruptionQuestion>
								<loic:InterruptionQuestionCode>QR06</loic:InterruptionQuestionCode>
								<loic:InterruptionQuestionAnswer>1</loic:InterruptionQuestionAnswer>
							</loic:InterruptionQuestion>
							<loic:InterruptionQuestion>
								<loic:InterruptionQuestionCode>QR13</loic:InterruptionQuestionCode>
								<loic:InterruptionQuestionAnswer>0</loic:InterruptionQuestionAnswer>
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						</loic:Questionnaire>
						<loic:InterruptionThresholdInformation>
							<loic:InterruptionWorkersThreshold>02</loic:InterruptionWorkersThreshold>
							<loic:AgreementDate>2019-06-01</loic:AgreementDate>
							<loic:NbrOfWorkers>05</loic:NbrOfWorkers>
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						<loic:CollectiveLabourAgreement>
							<loic:CLACode>CLA103</loic:CLACode>
						</loic:CollectiveLabourAgreement>
					</loic:EmployerInterruptionForm>
					<loic:CommentDeclaration>
						<loic:CommentOfDeclaration>Tijdskrediet met motief palliatief 1 vijfde </loic:CommentOfDeclaration>
					</loic:CommentDeclaration>
				</loic:LOIC001>
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