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Zorgtoeslag (Healthcare Allowance) Application

Tell us about you

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    Marital Status*

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Tell us about your stay in the Netherlands

    Do you have Dutch health insurance? *

    Are you in military service?*

    Are you in the Netherlands to study?*

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    I’m still in the Netherlands*

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    Did you register with the local authorities?*

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    Did you de-register with the local authorities?*

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What kind of income did you receive from the Netherlands? Please state the total amount in Euro for each

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* Please send us copies of all relevant records you kept for this income

    Did you receive any other income from sources outside the Netherlands?*

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  • valid
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    Do you have any savings or investments?*

  • valid
  • valid
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* The value of your home should NOT be included

    Which year would you like to apply for?*

Spouse / Partner

    Relationship*

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  • valid
  • valid

    Gender*

  • valid
  • valid
  • valid

Tell us about your Spouse / Partner stay in the Netherlands

    Do you have Dutch health insurance? *

    Are you in military service?*

    Are you in the Netherlands to study?*

  • calendar valid
  • calendar valid
  • calendar valid
  • calendar valid
  • calendar valid
  • calendar valid

    She / He is still in the Netherlands*

  • valid

    Did you register with the local authorities?*

  • calendar valid

    Did you de-register with the local authorities?*

  • calendar valid

What kind of income did you receive from the Netherlands? Please state the total amount in Euro for each

  • valid
  • valid
  • valid
  • valid
  • valid
  • valid
  • valid
  • valid

* Please send us copies of all relevant records you kept for this income

    Did you receive any other income from sources outside the Netherlands?*

  • valid
  • valid
  • valid

    Do you have any savings or investments?*

  • valid
  • valid
  • valid

* The value of your home should NOT be included