You will only need to fill in this form if you have received a letter from us asking you to do so. It is important that you complete it before the date we mention in the letter as otherwise we will not be able to process your application.

You will need either a DigiD account or a valid European electronic ID (‘Europees erkend inlogmiddel’) to submit information about your situation and health. The form will take around 60 minutes to fill in.

Please note: Make sure you have enough time to complete the form in 1 go. If you take a break for more than 15 minutes, you will be automatically logged out and will lose any information you have entered.

• a digital copy of a valid passport or identity card
• any up-to-date information from your family doctor (‘huisarts’) or medical specialist

Please note: If you have received documents from your doctor or specialist after completing the form, you can re-use the form to upload this information without having to re-enter your details or ID. Make sure you submit all the information as soon as possible as this will speed up the assessment of your application.

You can check the status of your application via Mijn UWV from the 2nd day of reporting your illness.

We will send you a letter with a decision on your sickness benefit within 4 weeks of your application. If you are entitled to a sickness benefit, the letter will also state the amount you can expect to receive.