Forms and documents
Overview of frequently used forms, digital requests and documents to order.
Request a refund
Eye care
To travel
- CM travel assistance: application for compensation for care abroad
- Travel vaccines: request reimbursement for vaccinations for travel abroad
Power supply
- Celiac disease: application for compensation for adapted nutrition | extension
- Enteral nutrition
- Gluten-free food: application for compensation for adapted food | extension
- Nutrition and diet advice
Spare time
Others
Incapacity for work and accident
- Declaration of incapacity for employees
- Declaration of incapacity for self-employed persons
- Application for a blank certificate of incapacity
- Accident report
- Application for permitted activity in case of incapacity for employees and self-employed persons, digitally
- Application for permitted activity in case of incapacity for employees, on paper
- Application for permitted activity in case of incapacity for self-employed persons, on paper
- Declaration of return to work for employees - proof of resumption of unemployment
- Proof of return to work for self-employed persons
Digital requests
- Application for certificate of income replacement benefits
- Application for certificate of enhanced reimbursements
- Request co-payment counter
- Application for permitted activity in the event of disability for employees and self-employed persons
- Complete the information sheet for benefits digitally
- Provide new bank account number
- Report or request permission to go on holiday while you are incapacitated for work