Application for certificate of benefits

Are you incapacitated for work, or have you been? For some authorities you need an overview of the periods during which you were incapacitated for work and/or of the benefits you received.

Disability benefit

When will I receive my benefit?

Would you like CM to issue such a certificate for you? Please complete the form below.

Voornaam

Familienaam

Rijksregisternummer

E-mailadres

Telefoon/gsm

Land

Postcode

Stad of gemeente

Periode waarvoor je een attest wenst:

van

tot

Moet het attest de bedragen van je vervangingsinkomen bevatten?

nee