tum .......... Orsak till {ndring .......... (koder, se nedan!) Anm .................................................................... Beslut ................................................................. ................................................................. Beslutsdatum .......... Underskrift .................................... [ndringskoder: A[ = anm{lan om {ndring IE = ifr}gasatt ers{ttningsr{tt AI = arbetsgivarintyg OM = ompr|vning \ = |vrigt --------------------------------------------------------------------------- [ndrings{renden: 41 Ankomstdatum .......... Orsak till {ndring .......... (koder, se nedan!) Anm .................................................................... Beslut ................................................................. ................................................................. Beslutsdatum .......... Underskrift .................................... 42 Ankomstdatum .......... Orsak till {ndring .......... (koder, se nedan!) Anm .................................................................... Beslut ................................................................. .................................................................