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Vertaling(en)
Translation
Pensioners who receive a pension from the Federal Pensions Services but no longer reside in Belgium are
required to provide a Certificate of Life every year. The “Certificate of Life” form the FPS has created
towards this end has to be completed each year and forwarded to the FPS within 30 days, otherwise we are
compelled to suspend your pension payments.

Why do you have to complete this form and send it to us every year?
In Belgium, the FPS is automatically notified by the local authorities about any change in address, marital
status, nationality, decease, … Consequently, the FPS may, if so required, adjust the pension entitlements
to the new situation. As no such information exchange system has been developed between the FPS and
non-Belgian authorities, pensioners living outside Belgium are themselves required to forward the necessary
information.

What do you have to do?
1. You should date and sign the front side of the enclosed form. This personal commitment is intended to
draw your attention to your obligations and the implications of the non-observance hereof.
2. If you are a Belgian national, have the back of this form completed, either by the Belgian Embassy or
the Belgian Consulate in your country of residence, or by the competent local authority (e.g. the mayor
or the local police),
If you are not a Belgian national, have the back of this form completed, either by the competent local
authority of your place of residence (e.g. the mayor or the local police), or by the consular authority of
your country.

3. If you were separated, married or remarried or become a widow (widower) recently you should enclose
a certificate to substantiate this. The official document should feature the date of the event and the
surname, first name and date of birth of your new spouse, where appropriate.
4. Check to see the form has been duly completed and signed. Send it to the FPS.

43082521789LIFE00101 ~ 000000110587417