All the forms for your insurances gathered here.



Pension@work 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 

Change the affiliate's personal choices 


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.           

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

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

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

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


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.​


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​