Forms for treaty-entitled persons

Go to Apply for a document S1/form 121 to download the application form. You can also read what conditions you have to meet and what you can expect.

Please note

Are you moving to Spain? You will need, among other things, a NIE number (evidence that you are an EU citizen, in Spanish only) to register with a Spanish health insurance company. Take into account long waiting times. Please inform the Spanish consulate (in Spanish and Dutch only) in advance of any more documents you need when emigrating and make appointments online.

Do you have an EHIC but have still had to pay a doctor or pharmacy directly in cash? In such a case you can still claim back the costs from us. Use the form Declaration, costs of medical care for treaty-entitled persons (7.12.2020, PDF, 601 kB).

If your family members no longer live or work in the Netherlands, they can no longer have Dutch health insurance. Do you work in the Netherlands? In some cases they can be co-insured under your policy in their country of residence. That is only possible, however, if they live in a treaty country and the local health insurance fund agrees.

Do your family members live in an EU/EEA country or Switzerland?

Do your family members live in another treaty country?

  • Apply to your Dutch health insurance company for a form 109.
Submit the form S1 or 109 to the local health insurance fund. If it agrees, your family members are co-insured. You will then pay a healthcare contribution for them.

More information

Please note

Are you receiving a pension or benefit from the Netherlands and are you moving abroad with your family members? Then use the regular form Apply for a document S1/form 121 for yourself and your family members.

Do you have a question and are you unable to find an answer on our website? Or do you have a request? If so, you can use the contact form to send us a message.

You can use the form Notification of bank details for treaty-entitled persons (12.5.2021, PDF, 499 kB) to let us know your bank account number.

Would you like your contribution to be debited automatically every month? If so, please contact us to authorise us to collect it in this way.

Do you disagree with a decision of the CAK? If so, contact us by telephone and we will try to find a solution together with you.

You can also lodge an objection. There are two ways to do this:

Print out the objection form

Print out the form Lodging an objection (7.12.2020, PDF, 1002 kB) and fill it in.

Please enclose the following documents:

  • a copy of the decision against which you are objecting
  • copies of any supporting documents
  • if someone else is lodging an objection on your behalf: an authorisation (7.12.2020, PDF, 566 kB)

Send a letter

Would you prefer to send us a letter? In that case include the following information in the objection letter you send:

  • your name, address and email address
  • the date on which you are sending the objection letter
  • a description of the decision against which you are objecting (quote the date and decision number)
  • the reason why you disagree with the decision
  • your citizen service number (BSN)
  • your telephone number

Please enclose the following documents:

  • a copy of the decision against which you are objecting
  • copies of any supporting documents
  • if someone else is lodging an objection on your behalf: an authorisation (7.12.2020, PDF, 566 kB)

Sign the objection letter and send it to:

CAK

Afdeling Bezwaar & Beroep

Antwoordnummer 91041

2509 VC The Hague

No stamp is needed.

Please note

Are you writing to us from abroad? In that case please use the following address:

CAK

Afdeling Bezwaar & Beroep

Postbus 84030

2508 AA The Hague

Find out more about how we handle an objection

Are you unhappy with the service we have provided? If so, contact us by telephone and we will try to find a solution together with you.

You can also fill in a complaint form or send us a letter.

Complaint form

Fill in the online Zvw complaint form. Please indicate clearly that you are making a complaint and provide your address details and a telephone number that we can use to contact you.

Send a letter

Would you prefer to send us a letter? Please include the following information:

  • Your name
  • Your address
  • Your date of birth
  • The date on which you are sending the complaint
  • What your complaint is about
  • Your citizen service number (BSN)
  • Your telephone number, so we can call you to discuss the matter personally

Send your complaint to:

CAK

Antwoordnummer 91042

2509 VC The Hague

No stamp is needed.

Please note

Are you writing to us from abroad? In that case please use the following address:

CAK

Afdeling Bezwaar & Beroep

Postbus 84030

2508 AA The Hague

Find out more about how we handle a complaint

Last modified on 16 June 2021

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