In addition to application Form SSA-2490 (paper or MCS version), a person applying for Dutch benefits must complete a separate Dutch application form. Claimants filing for Dutch retirement benefits must normally complete Dutch form NL/VS 202, while claimants filing for survivors benefits must complete Dutch form NL/VS 203.

The Dutch application forms are not taken in Field Offices (FO). After receiving a claim for Dutch benefits that was filed with SSA, the Dutch agency will mail the appropriate form to the applicant. The Dutch agency will include instructions asking the claimant to complete the forms and mail them directly to the Dutch agency along with any additional evidence that may be needed.

If an applicant brings one of the Dutch application forms to the FO:

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  provide any necessary assistance in completing the form,

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  photocopy and certify any documents (evidence) the Dutch agency has requested the applicant to include with the Dutch claim, and

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  return the forms (and certified photocopies) to the applicant and advise him/her to mail them directly to the Dutch agency that sent them.

REMINDER: Do not mail the Dutch application forms to OIO.