Submission <br/>illness certificate</php>

As a VF Europe staff member, you use this web form to submit your illness certificate to the medical inspection service Mediwe.

Enter your date of birth and zip code of your place of residence below, this is mandatory.

On the next page of this web form, enter the details of your illness certificate and your contact details, so that your file can be processed smoothly.
On the last page you upload a photo or scan of the illness certificate that your doctor provided to you. This is also a mandatory step.

This form does not replace reporting your illness.

You still inform your department of your illness and its duration via the reporting number (EDC) or via your own department (ABX).

Questions about this web form?

If you have any questions, you can contact Mediwe during office hours (from 1:15 PM to 4 PM) on 03/220.61.00 or by email mediwe@mediwe.be.

Personal data

Enter your date of birth:

Day *	Month *	Year *

The postal code of your place of residence is: *

Your surname: *

Details of your illness certificate

The document you wish to forward is a: Illness certificate from the doctor Illness certificate form in case of illness during annual vacation

Reason for your work disability * : Illness Private accident Work accident Family leave Progressive return to work Illness without certificate Request for custom work

Prescribed period of illness

Start date End date

Leaving the home is : Allowed Forbidden

This is an extension of your illness period I stay during my absence at another address

Street and house number

Postal code

City Country

Admission to hospital

Contact details (optional)

Mediwe can contact you via the details you provide below (telephone or mobile number):

The email address at which you wish to receive a confirmation.
Mediwe will only send the confirmation after checking and processing your illness certificate.

Submission illness certificate