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Forms

All the forms for your insurances gathered here.

Classical Life / Pension4Life

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      
Use the Application for enrolment form to enrol a new employee (except the Evolulife plan).
ENFR - NL DE


Beneficiary(ies) in the event of death

Change in marital status, in the number of children
Use the Notification of change form to make a change to the marital status, number of children, etc. of the affiliate. For the new enrolment of a family member in the healthcare plan, use the special healthcare enrolment form.                                                          
EN FR - NL - DE

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.      
EN FR - NL - DE



Explanatory note in the event of the designation or change in beneficiary(ies)  
EN FR - NL


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


Designation/change in the beneficiary(ies) in the event of death (3rd pillar)
FR - NL - DE
        

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


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 Declaration of Liquidation form if your affiliate retires or takes a form of early retirement. 
Print the form and complete the section about you. 
Ask the affiliate to complete the section about him, sign the form and send it to you with a photocopy of the front and back of his identity and SIS cards. 
If the affiliate's tax residence or the location of his 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  

                           
Death

Use the Notification of death form if you have to report the death of an affiliate.

Print the form and complete your section.

Ask the beneficiary to fill in the section about him, to sign the form and send it to you with:

an extract of the death certificate of the affiliate 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 his wealth is abroad: a tax certificate. You must provide the following for this purpose.

EN - FR - NL