Forms Income Care

 

Our forms are different depending on your plan type. In order to better meet your needs, we request that you use the correct forms.

You can ask your human resources department for information about your plan.

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  • Report an occupational incapacity
    
 
  • Claim notification
  NL  FR  EN  DE  
 
  • Medical certificate
 

NL

 

FR

 

EN

DE

 
  • Occupational incapacity insurance
         
 
  • Request for individual continuation coverage
  NL  FR