Temporarily unemployed ?

Are you a ABVV member ? (*)

I work as : (*)

National number : (*)

This number can be found on the back of your identity card. Only use numbers, no spaces or punctuation marks.

Please enter your national number.

Last name : (*)

Please enter your last name.

Name : (*)

Please enter your name.

Nationality :

Street : (*)

Please enter your street.

House number : (*)

Please enter your house number.

Annex :

Postal code : (*)

Please enter your postal code.

Locality : (*)

Please enter your locality.

Account number : (*)

Please enter your account number.

Email address : (*)

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Mobile : (*)

Please enter your mobile number.

1st day of temporary unemployment :

Name of employer :

Zip code place of employement :

I work :

Do you have other income (eg self-employed person in a secondary occupation,
additional employer, political mandate, compensation for an accident at work, ...) ?

What income ?

Have you ever had an unemployment record with another union or 'Hulpkas/CAPAC' ?

Where did you have this file ?

I agree to the general terms and conditions (*) I hereby give mandate to ABVV-FGTB to introduce my application with RVA in my name. I declare that the information I entered is complete and correct. I explicitly agree that if ABVV makes an undue payment based on data that is not truthful, I am obliged to repay it.

Please accept the general terms and conditions.

Fill in all information as completely and correctly as possible

Fields with (*) are obligated