Online declaration of incapacity for work

You can complete your incapacity for work declaration online using the form below.

Complete the form and attach your certificate of disability. You must first have this certificate completed by your doctor (as an employee or as a self-employed person ). Then you scan it or take a photo of it. Finally, you add the declaration as an attachment to this form.

Submit the declaration within 7 calendar days after the start of your incapacity for work, or before the end of your period of guaranteed wages . This way you avoid a reduction in your benefit or a sanction.

You do not have to provide us with the certificate intended for your employer.

Important: here you can only submit your incapacity for work declaration, not the benefits information sheet. You can complete the information sheet here .

First name

Family name

Country

Postal Code

National registration number

Email address

Doctor's name

Start date of incapacity for work stated on the certificate

End date of incapacity for work stated on the certificate

Certificate of disability

Here you only need to submit the completed and signed pages of your certificate.
N ot the benefits information sheet. You fill that in here .
One file only. 10 MB limit. Allowed types: pdf, jpg, jpeg, png.

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Try the track and trace for incapacity for work in the My CM app

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