Obtain a request for a foreign benefit form

If you were insured in one of these following countries: Albania, Brazil, Canada. Quebec, Chile, USA, Israel, Japan, North Macedonia, San Marino, Tunisia, Türkiye, Philippines, Bosnia-Herzegovina, Montenegro, Serbia, Kosovo, India, Uruguay, United Kingdom or Australia, please fill out the form below and specify the concerned country and the kind of benefit.

The sections with an asterisk (*) must imperatively be filled out in order to process your request

Error in order form

Selection

Mister

Mister

Madam

Madam

OASI number

 

Present nationality

*

Surname

*

Previous surnames

 

First name/s

*

Date of birth (dd.mm.yyyy)

*

Street, number

*

Zip / Post code

*

Town

*

Country

*

Telephone number

 

Email

*

Type of benefit

*

Old-age

Old-age

Survivor

Survivor

Disability

Disability

Countries concerned

*

Albania Australia Bosnia and Herzegovina Brazil Canada Chile India Israel Japan Kosovo Montenegro North Macedonia Philippines San Marino Serbia Tunisia Türkiye United Kingdom United States Uruguay

Last modification 19.03.2024