- Disability Request Form
Disability Request Form
Step 1. Please complete the ‘Disability Pension Benefit Request’ form below.
Step 2. Once completed, please click ‘Submit’ and then click ‘Download form’
Step 3. Please print your completed form and sign the form with your name and signature.
Step 4. Please scan your signed form, upload it and click ‘Submit’
Please note that it is necessary to include the following documents with this registration:
- Copy of valid picture ID (passport, ID card, driver’s license)
- Detailed Extract form Civil Registry (“Uitgebreid uittreksel Burgerzaken”)
- Salary specification letter from your last employer(s) stating the salary amounts earned from January 2018 until retirement date and confirming your employment history (for verification purposes)
- Proof of additional income from business or other employment that is subjected to wage tax
- Copy of bank statement/bank book (for verification purposes)