Do you have a complaint about an insurance company? | Federal agency for occupational risks

Form

Do you have a complaint about an insurance company? Please complete this form so that we can assist you further.

Please fill in all mandatory fields (*) so that your details can be processed correctly.

You can read how Fedris uses your personal data in our privacy notice (GDPR).

First name of the victim

Last name of the victim

National Register Number of the victim

11 digits, without spaces or hyphens

Street

House number (and box, if applicable)

Postal code

City

Country

Phone number

E-mail

Date of the workplace accident

Naam van de werkgever

Name of the employer

Name of the insurance company

File number with the insurance company

Front and back of the identity card*

Maximum 2 files.
10 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip.

Your complaint

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