APS

Smartengeld Request Form

Step 1. Please complete the ‘Smartengeld / Burial Allowance 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)
  • Death certificate of the deceased family member from whom pension benefits rights are derived
  • Detailed Extract form Civil Registry (“Uitgebreid uittreksel Burgerzaken”)
  • Copy of invoices for Funeral Costs
  • Copy of bank statement/bank book (for verification purposes)
  • Authorization letter (if applicable)

SMARTENGELD BURIAL ALLOWANCE REQUEST FORM

A. SUBMITTER

Name(Required)
Address(Required)
DD slash MM slash YYYY
Sex(Required)
Preferences

B. DETAILS ON PERSON FROM WHOM RIGHTS ARE DERIVED (DECEASED)

Name(Required)
DD slash MM slash YYYY

C. RELATION TO DECEASED

Relation to deceased(Required)

D. BESIDES THE ‘SUBMITTER’, ARE THERE ANY OTHER KNOWN RELATIONS AS MENTIONED IN SECTION B ABOVE, INVOLVED?

Name
DD slash MM slash YYYY
Marital Status
Name
DD slash MM slash YYYY
Marital Status
Name
DD slash MM slash YYYY
Marital Status

E. 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.

F. 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.

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.
Scroll to Top