Apply for a document S1/form 121

You must apply for a document S1/form 121 from the CAK if you: 

  1. Have a statutory pension or benefit from the Netherlands and;
  2. You live or go to live in a treaty country and;
  3. You no longer work in the Netherlands and you do not own a business.


You will be notified within 6 to 8 weeks. There are 3 options.

We approve your application

You will receive a document S1/form 121. This allows you (and your family members) to register with the health insurance fund in your country of residence. Your country of residence will cover your healthcare costs with the Netherlands. You will have to pay a healthcare contribution to the CAK. This amount is deducted monthly from your pension or benefit.
Please note: In some countries we send the document S1/form 121 directly to the health insurance fund in your country of residence. We will inform you if this is the case. 


If the effective date of your pension and/or relocation is in the past, you are usually also insured retroactively. You will then pay a treaty contribution from that date.

We need additional information from you

We may need additional information to assess your application. We will send you a letter containing the questions we still have. 

We reject your application

You are not entitled to health insurance through the CAK. The letter you will receive from us will tell you why. Do you not agree with the rejection? Then you can always object.

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 contact the Spanish consulate (Spanish and Dutch only) in advance to inform about any more documents you need when emigrating and make appointments online.

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