Early return to work

If you return to work before the end of your certificate of incapacity for work, simply inform us by completing the form below.

You do not need to provide a new medical certificate from your doctor to return to work.

Please make your declaration no earlier than two days before you actually return to work.

IMPORTANT

If you are long-term incapacitated for work and have already received a summons to attend the Contrôle médical de la sécurité sociale (CMSS), you must fill out the reply form (talon-réponse) on the back of the summons you received by post and return it to the address shown on the reply form.

Fields marked with an asterisk (*) are mandatory.

Surname *

First name *

13-digit identification number *

Email *

Le format de date attendu comprend le jour (sur deux chiffres) suivi du mois (sur deux chiffres) suivi de l'année (sur quatre chiffres) : chacune de ces valeurs est séparée par un tiret.

Start date of your incapacity for work *

Le format de date attendu comprend le jour (sur deux chiffres) suivi du mois (sur deux chiffres) suivi de l'année (sur quatre chiffres) : chacune de ces valeurs est séparée par un tiret.

Initial end date of your incapacity for work *

Le format de date attendu comprend le jour (sur deux chiffres) suivi du mois (sur deux chiffres) suivi de l'année (sur quatre chiffres) : chacune de ces valeurs est séparée par un tiret.

Effective date of early return to work *

Tick the following box *

By ticking this box, I am aware that in accordance with Article 169 of the CNS's Statutes, a return to work before the presumed end of the incapacity for work as certified by the prescribing doctor on the medical certificate of incapacity for work puts an end to the incapacity for work.

* Mandatory field

Personal Data

To complete your application, the information about you collected from this form needs to be processed by the public administration concerned.

That information is kept by the administration in question for as long as it is required to achieve the purpose of the processing operation(s).

Your data will be shared with other public administrations that are necessary for the processing of your application. For details on which departments will have access to the data on this form, please contact the public administration you are filing your application with.

Under the terms of Regulation (EU) 2016/679 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, you have the right to access, rectify or, where applicable, remove any information relating to you. You are also entitled to withdraw your consent at any time.

Additionally, unless the processing of your personal data is compulsory, you may, with legitimate reasons, oppose the processing of such data.

If you wish to exercise these rights and/or obtain a record of the information held about you, please contact the administration in question using the contact details provided on the form. You are also entitled to file a claim with the National Commission for Data Protection (Commission nationale pour la protection des données), headquartered at 15, Boulevard du Jazz, L-4370 Belvaux.

By submitting your application, you agree that your personal data may be processed as part of the application process.