Proxy

Identity of the principal:

First name:
Name:
Adress:
Date of birth:
Pension number:

Identity of the proxy:

First Name:
Name:
Adress:

 

Nature of the proxy:

I agree that the proxy mentioned above:

  • files a complaint about the treatment of my pension file or about the calculation or payment of it;
  • informs the Ombudsdienst Pensioenen of any information necessary to the treatment of my complaint;
  • receives all information concerning my complaint.

This proxy ends its effects the day my file will be closed by the Ombudsdienst Pensioenen.

 

Date Signature of the principal