Notification of a change

Transcription

1 AOW pension Notification of a change Changes in your personal circumstances may affect your AOW pension entitlement. You must therefore report changes to the SVB within four weeks, using this form. People living outside the Netherlands must report changes within six weeks. 1 Personal details This section must always be completed. burgerservicenummer If you do not have a burgerservicenummer, fill in your SVB registration number. initials and surname daytime telephone number 2 Type of change Fill in the section that refers to the change you wish to report and sign the form. Type of change my address Complete section 3. account number Complete section 4. my or my partner s income Complete section 5. domestic situation (composition of household) Complete section 6. detention/imprisonment Complete section 7. death of partner (only report this if your partner was living outside the Netherlands) Complete section 8. residence outside the Netherlands Complete section 9. nationality Complete section Address You are not required to report a change of address in the Netherlands. If you are moving in with someone, go to section 6. the change concerns my home address my postal address Does this change also apply to your partner or housemate yes no I do not have a partner or housemate 7111ET/0315 next

2 Notification of a change 2 of 5 4 Bank account number You can find your IBAN number on your bank statement or your online banking site. The BIC code and name and address of the bank are only necessary for countries outside Europe. Do not close your old account until you have received a payment from the SVB in your new account. If you live in the Netherlands or another European country If you live outside Europe IBAN BIC account number / IBAN (only if you live in the United Kingdom) BIC name of the bank address of the bank 5 My or my partner s income in your partner s income - Only report a change in income if you receive an AOW supplementary allowance for your partner. - You do not have to report any changes in steady income from wages, pension or benefit from the Netherlands. These changes are reported to us by the Dutch Tax Administration (Belastingdienst). In case of a major change, for example if you or your partner starts or stops working or if a benefit is discontinued, we advise you to report the change yourself, so that we can adjust your supplementary allowance earlier, as the information we receive from the Tax Administration is at least two months old. If you report the change yourself, please enclose copies of documentary evidence, such as a payslip or benefit statement (not an annual statement). - If your income varies, if you have income from self-employment or business, or if you have income from outside the Netherlands, you should always report any changes to us, enclosing copies of documentary evidence. my partner s income has gone up my partner s income has gone down my partner has a new source of income my partner no longer has income Date of change in your income my income in addition to my AOW pension has gone up my income in addition to my AOW pension has gone down I have a new source of income in addition to my AOW pension I no longer receive any income in addition to my AOW pension Date of change

3 Notification of a change 3 of 5 6 Domestic situation Tick the applicable box to indicate the type of change in the composition of your household. Information on marriage, registered partnership and divorce is provided to us by the Dutch municipal population register. I am married or in a registered partnership and live with my partner or spouse Fill in the details below. Only report this if you live outside the Netherlands. I am married but separated from my spouse and live on my own. I m married but separated from my spouse and live with someone else Fill in the details below. I am divorced and live on my own. Only report this if you live outside the Netherlands. I have a subtenant or boarder Send copies of the contract and proof of payment (bank statements). my partner has been admitted to a nursing home name of nursing home I am no longer unmarried and living with a partner I am unmarried and have started living together with: my partner Fill in the details below. my child This includes a stepchild or foster child. date of birth of child: another family member Fill in the details below. someone else Fill in the details below. surname first name(s) date of birth

4 Notification of a change 4 of 5 7 Detention / imprisonment I have been detained/imprisoned This also applies to pre-trial detention or similar. Name and address of custodial institution: I have been released from detention 8 Death of partner By partner, we mean the person with whom you share a household. You are only required to report this if your partner was living outside the Netherlands. your late partner s name date of birth date of decease 9 Residence outside the Netherlands I am going to live in another country province and country 10 Nationality You only have to report a change of nationality if you live outside the Netherlands. Whose nationality has changed my nationality has changed my partner s nationality has changed What is the new nationality

5 Notification of a change 5 of 5 11 Remarks Please state the number of the section to which your remark refers. 12 Signature date I declare that the information on this form is true and complete. signature Return this form, together with any enclosures, to your SVB office.