This form is intended for people living abroad who might qualify for a sickness or WIA benefit. You will only need to fill in this form if you have received a letter from us asking you to do so. Additionally, 1 of the following situations must apply to you:
Let us know where you would like to have the medical examination by completing the form Preference for medical examination in your country of residence or in the Netherlands. You will need either a DigiD account or a valid European electronic ID (‘Europees erkend inlogmiddel’) to access this form.
Once we have received your form, we will contact you with more information about the medical examination.
This form is also available in Dutch, French, German and Polish: