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Hed ! Application for family allowances for a salaried employee (paid by the employer) Employer Affiliate number Company name To be filled in by the claimant If the children are born of several unions, please fill in a questionnaire for each union. Ms. Surname / First name Mr. Private address Street / No. Post code / Place Phone NSS no. replaces AVS no. Date of birth Nationality if you are a non-EU national, please enclose a copy of your residence permit Civil status.

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