Make a claim
Home Declaration of work disability - Employer

Declaration of work disability - Employer

 
1 Instructions 2 Employee data 3 Employer data 4 Documents 5 Review submission 6 Completed

Instructions:

Before reporting a disability, we ask you to have the following documents digitally available:

  • Employer work disability declaration form - to be completed by the employer (Download form)
  • Disability certificates

 

Once you have filled out and have these documents available, you can proceed to the next step.

 

"By completing this form, you expressly authorise NN Insurance Belgium SA/NV (AvenueFonsny38, 1060 Brussels), in its capacity as data controller, to process your health data, which you communicate to us in the context of the processing of your "disability file”.