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Application for disability or occupational disability pension

Please take note of the explanations in the information sheet

Personal information of the applicant

Title (preceding)

First name*

Last name*

Title (postpositioned)

Former name (1)

Former name (2)

Former name (3)

Gender*

Social security number*

Date of birth (DD.MM.YYYY)*

Place of birth*

Country of birth*

Native language (if not German)

Marital status*

seit*

Nationality*

since

Country*

Street*

House number*

Stairway

Floor / Door

Postcode*

Town*

Telephone incl. area code

(FORMGEN_FORMSERVER / 1.2.4) 2026-10-05 16:50:56.173