Request form A1

Fields with a * are required

Data applicant if NOT the person for which the certificate is meant

Personal data applicant

Data correspondance:

Data concerning the self-employed activity in Belgium

Nature of business or occupation:

Data concerning the business/company in Belgium:

For which period do you want to request the A1 form?

Countries No fixed address in another country Name of the business/company abroad Address of the business/company abroad
Date 15 December 2018