APS

Widow(er)’s/ Orphan Request Form

Step 1. Please complete the ‘Widow(er)’s / Orphan’s 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)
  • Death certificate of the deceased family member from whom pension benefits rights are derived
  • Declaration of school attendance for orphans if between the ages of 18 and 27 years
  • Copy of bank statement/bank book (for verification purposes)

WIDOW(ER)’S /ORPHAN’S PENSION BENEFIT REQUEST

SUBMITTER

Name(Required)
Sex(Required)
Address(Required)
DD slash MM slash YYYY
Marital Status(Required)
Type Pension Requested(Required)
Preferences

DETAILS ON PERSON FROM WHOM RIGHTS ARE DERIVED

Select Category(Required)
Name(Required)
DD slash MM slash YYYY
DD slash MM slash YYYY

BANK DETAILS

Note: This must be a local or ING account. Note: If the orphan is still a minor, this form must be completed and signed by his /her parent or legal guardian. Pension benefits payment will be made to a bank account held in the name of the parent and /or legal guardian. If the orphan does not have his /her own bank account, an authorized beneficiary must be named.
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.

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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