Forms for treaty-entitled persons

If you move to a treaty country and are receiving a pension or benefit from the Netherlands, you can fill out the form Application for a document S1/form 121 (7.12.2020, PDF, 758 kB). On the basis of your application we will assess whether you are entitled to Dutch-funded medical care. If you are entitled to such care, we will send you the S1/121. This form allows you to register with a health insurance fund or company in your country of residence. Only after registration can you use medical care in your country of residence.

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).

You can use the form Notification of bank details of a treaty-entitled person (7.12.2020, PDF, 464 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 1608

2509 VB The Hague

No stamp is needed.

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 1608

2509 VB The Hague

No stamp is needed.

Find out more about how we handle a complaint

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.