Declaration of good health

Verklaring van goede gezondheid (Engelstalig). This model contains a declaration of good health, which can be used, for example, in connection with a severance agreement or an annuity agreement. The insured person declares whether they have received medical treatment during the past 24 months and confirms their current state of health. The form constitutes part of the process of entering into the agreement. This template is intended for insured persons and contracting parties who need to document medical information in connection with an insurance policy or annuity agreement.