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Full name Required BSN (Citizen Service Number) Required 🔒 Stored encrypted; only used to generate your draft. Date of birth Required Format: DD/MM/YYYY 🔒 Stored encrypted; only used to generate your draft. Home address in the Netherlands Required First day of illness Required Format: DD/MM/YYYY Re-integration report uploaded? Required Required re-integratieverslag covering the 2-year sickness period. Current employer (if any) Optional Nature of disability Required 🔒 Stored encrypted; only used to generate your draft. Treating physicians Optional 🔒 Stored encrypted; only used to generate your draft. Average monthly wage before illness (€) Required 🔒 Stored encrypted; only used to generate your draft. Currently able to work (% of prior role) Required Estimated share of your old job you could still do; UWV will verify with a medical assessment. Simplified assessment (60+ at first day of illness)? Required If you turned 60 before falling ill, you can opt into the simplified WIA assessment.

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