Forms

All the forms for your insurances gathered here.

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Classical Life / Pension4Life e-volulife Pension@Work Hospicare Flexible Ambucare Flexible Income Care Income Care / e-volulife Income Care / Pension@Work

e-volulife

e-volulife pension and death

You may sign the completed forms and return them to AG Employee Benefits, for the attention of the administrator of your plan, at

     Boulevard Emile Jacqmain 53
     1000 Brussels​



New enrolment

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EN - FR - NL 
            

Change the affiliate's personal choices
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 EN - FR -  NL


Death

Use the Notification of Death form to report the death of a plan participant.

Print out the form, fill out the details and answer the questions in cases where you have the information, and sign the form. 

​Ask the plan participant’s spouse, registered domestic partner or other rightful heir(s) to complete the rest of the form and to sign it.​ 

Attach the documents listed on page 3 of the Notification of Death form.

You can either send these documents back to AG yourself, or have the plan participant’s spouse, registered domestic partner or other rightful heir take care of it.​

EN - FR - NL​


Tax residence or location of wealth abroad

EN - FR - NL - DE - ES


Beneficiary(ies) in the event of death

Designation/change in beneficiary(ies) in the event of death
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/change in the beneficiary(ies) 
EN - 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                                               


Early retirement:    

Use the Notification of Liquidation form 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

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