Request a certificate for a workplace accident (private and public sector)

Form

Do you need a certificate regarding your work accident, for example to prove the degree of permanent incapacity for work, the date of consolidation or the amount of your compensation?

Please fill in all mandatory fields (*). The document will then be sent to you by post.

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

First name

Last name

National Register Number

11 digits, without spaces or hyphens

Street

House number (and box, if applicable)

Postal code

City

Country

Phone number

E-mail

File number

Datum van uw arbeidsongeval

I would like a certificate to prove

the degree of permanent incapacity for work

the date of consolidation of the occupational accide

the gross amount of occupational accident benefits

the net amount of occupational accident benefits

the date of the occupational accident

Other

Comments

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