Privacy regulations limit the duration of the validity of your consent. We invite you to renew your consent for the use of cookies on our websites.

We use cookies to optimise user experience, offer personalised information, and allow information sharing on social media. The consent you are giving by clicking on 'I agree' is valid for all AG Insurance websites. Also consult our Cookie Policy and our Privacy Notice.

Forms

All the forms for your insurances gathered here.

Pension-at-work

Pension@work pension and death


Fill in this form, sign it and return it to AG Employee Benefits to the attention of your plan manager at Boulevard Emile Jacqmain 53, 1000 Brussels.


New enrolment 
FR - NL

Change the affiliate's personal choices 

FR - NL

Beneficiary(ies) in the event of death

Designation/change of beneficiary(ies) in the event of death (2nd pillar)
The affiliate must fill in and sign the form. It must then be sent directly to AG Employee Benefits at the address provided on the form.           
FR - NL

Waiver of the application of Article 110/1 LCAT (2nd pillar)
 FR - NL

Waiver of the application of Article 110/1 LCAT (3rd pillar) 
FR - NL

Notification of departure from a plan
Use the Departure form if the employment contract of your affiliate is terminated for a reason other than retirement, early retirement or death.
 EN - FR - NL - DE

Early retirement
    

Use the Notification of Liquidation if your affiliate retires or takes early retirement.

Print the form and complete the section about you.
Ask the affiliate to complete the section about them, sign the form and send it to you with a photocopy of the front and back of their identity and SIS cards.
if the affiliate's tax residence or the location of their wealth is abroad: tax certificate. You must provide the “tax residence or location of wealth abroad” document to the affiliate in the language of the country in question.


Notification of liquidation

EN - FR - NL - DE

Notification of early surrender
EN - FRNL - DE 

Tax residence or location of wealth abroad
EN - FR - NL - DE - ES  


Death

Use the Notification of death form if you have to report the death of an affiliate.
Print the form and complete the section about you. 
Ask the beneficiary to complete the section about them, sign the form and send it to you with: 
an extract of the death certificate including the place and date of the death, 
a photocopy of the front and back of the identity and SIS cards of the beneficiary(ies), 
a notarial certificate, if the beneficiary(ies) (other than the spouse) (was)were not designated by name. The certificate should provide the last names, first names, dates of birth, civil status and addresses of the legal heirs of the affiliate, 
if one or more beneficiaries is(are) (a) minor(s) and no longer have a mother or father: the special authorisation of the judge of the peace authorising the tutor to collect the funds, 
if the services provided by the contract must be converted into an annuity: a certificate of life of the beneficiary(ies), 
if the affiliate's tax residence or the location of their wealth is abroad: a tax certificate. You must provide the “tax residence or location of wealth abroad” document in the language of the country in question for this purpose.

EN - FR - NL - DE


The information required by the Verwilghen Act
(healthcare insurance and income protection)                                                                                    
                                                                                           

Pre-financing information document
The pre-financing information document must be provided by the employer to all of their insured employees and whenever a new person is hired. This ensures that the employer fulfils his information obligation under the Verwilghen Act. Given the severe sanctions, it is recommended that an acknowledgement of receipt be signed by the employees. 
For group hospitalisation insurance, the employer must also provide the AG Care Vision form.

EN - FR - NL - DE


AG Care Vision form
AG Care Vision is an individual hospitalisation insurance plan which meets the legislator’s objective of encouraging pre-financing.
Employers who take out group hospitalisation insurance for their employees must provide them with the AG Care Vision form and the pre-financing information document.
EN - FRNL                                                                     


Request for individual continuation coverage
This document must be provided to the employee at the latest 30 days after the end of affiliation or the loss of  group healthcare insurance or income protection coverage. The document consists of two parts:
The first must be completed by the employer.                   
The second is for the employee requesting individual continuation coverage.
The two documents must be sent to the employee. 
EN - FR - NL - DE