APS

Pension Premium Restitution Request Form

Step 1. Please complete the ‘Pension Premium Restitution 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)
  • Official employer’s overview of your pension premiums paid over your years in service for APS employer (less than 5 years)
  • Dismissal letter from your employer
  • Salary specification showing the salaries over your employment period
  • Copy of deregistration Sint Maarten (uitschrijfbewijs)
  • Detailed Extract form Civil Registry (“Uitgebreid uittreksel Burgerzaken”) stating that you are not divorced
  • Copy of bank statement/bank book (for verification purposes)
  • Copy of ID spouse (if married)

PENSION PREMIUM RESTITUTION REQUEST FORM

SUBMITTER

Name(Required)
DD slash MM slash YYYY
Sex(Required)
Address(Required)
Marital Status(Required)
Current Spouse Name
MM slash DD slash YYYY
Ex-Spouse Name: (if applicable)
MM slash DD slash YYYY
MM slash DD slash YYYY
Preferences

EMPLOYMENT DETAILS

MM slash DD slash YYYY
MM slash DD slash YYYY
Numbers of hour per week(Required)

RELOCATION DETAILS (If different from address above)

Address

BANK DETAILS

Note: This must be a local or ING account.
Bank(Required)

Bank Address(Required)
Account Type(Required)
Currency Type(Required)
Note: This must be a local or ING account.

UPLOAD NECESSARY DOCUMENTS

Please ensure that the documents substantiating your pension request are submitted with this form.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.

To sign this form, please follow the steps below:

1. Submit and download your form. 2. Write your full name and sign your form. 3. Please click on the 'Upload signed form' button below.
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