Make a claim
Home Declaration of work disability - Self-employed

Declaration of work disability - Self-employed

 

 

 
1 Instructions 2 Your details 3 Documents 4 Review submission 5 Completed

Instructions:

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

  • Medical certificate form - to be completed by the treating physician (download here)
  • Insured person's declaration form - to be completed by you (download here)
  • Disability certificates
  • Medical reports (e.g. operation reports, hospitalization reports, specialist progress reports, etc.)
  • Copy/ scan of your ID-card
  • Copy/ scan of your private bank card or bank statement
  • Copy/ scan of your corporate bank card or bank statement

 

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”.