Get Declaratieformulier

The Declaratieformulier is a crucial document for users seeking reimbursement for travel costs related to healthcare appointments. This guide will help you navigate each section of the form to ensure it is filled out correctly and clearly, facilitating an efficient claims process.

Follow the steps to fill out the Declaratieformulier online effectively.

1. Press the ‘Get Form’ button to access the Declaratieformulier and open it in your preferred editor.
2. Enter your polisnummer (policy number) in the corresponding field. This information identifies your insurance policy.
3. Provide your verzekerdenummer (insurance number). This helps to link your claim to your personal details.
4. Fill in the details of the insured person. Include their full name and initials in the designated area.
5. Enter the geboortedatum (date of birth) to confirm the identity of the insured individual.
6. Complete the section for straat en huisnummer (street and house number) with your current address.
7. Fill in the postcode and woonplaats (postal code and place of residence) where you currently live.
8. Input your telefoonnummer (telephone number) for any needed follow-up regarding your claim.
9. Provide your rekeningnummer (bank account number) where the reimbursement will be credited.
10. In the specificatie reiskosten (specification of travel costs) section, list the date, starting location (van), destination (naar), the number of kilometers (aantal km) travelled, and the reason for travel.
11. Add the total amount (totaalbedrag) incurred for the journey.
12. Attach copies of the appointment card and/or declaration from the visited institution like a hospital, doctor, or physiotherapist, as required.
13. If you traveled by public transport, ensure that proof of this travel is included.
14. Confirm that all information is accurate by writing the date and place of completion.
15. Send the completed form along with any attachments to Turien & Co. Assuradeuren, at the address provided.
16. Sign the form to validate your submission before finalizing the process.

Complete your documents efficiently by filling out the Declaratieformulier online today.