TN 1 (03-99)
GN 01725.230 Dutch Life Certificates
Under the agreement, SSA will help Dutch beneficiaries who live in the United States complete a life certificate form. This bilingual form must be completed each year by persons receiving Dutch benefits to verify the person's identity and continuing eligibility. The person must have it authorized by a certifying authority. SSA is shown on the form as one of the acceptable certifying authorities.
When the Dutch agency sends a claimant in the United States a Dutch application to complete, it also includes a life certificate form. The claimant is instructed to reproduce the form each year and complete it during the month of his/her birth. The certificate must then be certified and returned to the Dutch agency.
If a Dutch beneficiary brings a life certificate form to a FO, someone at the SR level or higher should:
help the beneficiary complete the certificate form, if necessary,
verify the identity of the beneficiary,
NOTE: Any proof of identity which satisfies SSA's requirements for issuing an SSN is acceptable (see RM 10210.010).
If the beneficiary does not have acceptable evidence:
return the form to him/her and explain that SSA cannot certify the form based on the evidence presented, and
advise the beneficiary that he/she may submit additional evidence or take the form to another certifying agency shown on the form.
sign the form to certify that the beneficiary appeared and established his/her identity,
If the form contains a space for a stamp or seal, use the FO date stamp, and
return the form to the beneficiary as he/she is responsible for sending the certificate to the Dutch agency.