Poland

The life certificate form constitutes written proof of your existence and, besides, of the fact that you are an Israeli resident. In order to keep on receiving social advantages from Poland, beneficiaries have the obligation to confirm their existence by signing this form. Furthermore, the form proves that you are living in Israel and thus that the convention between Israel and Poland applies.
The form must be filled out in Latin and capital letters, be signed by a competent agent. Agents with the competence to confirm your signature are: branches of the National Insurance and the Ministry of Interior of Israel, a public notary, a person authorized by a Polish diplomatic or consular mission.

Please, return the form directly to the address of the ZUS unit mentioned on this form.

Claim form to obtain an old-age pension from a Polish institution, to be completed by the person residing in Israel. the form must be filled out in clear handwriting and together with required documents in attachment.
Once completed and signed, the form must be sent to the International Affairs Division.

Claim form to obtain a survivors pension from a Polish institution, to be completed by the person residing in Israel. the form must be filled out in clear handwriting and together with required documents in attachment.
Once completed and signed, the form must be sent to the International Affairs Division.

Claim form to obtain a survivors pension from a Polish institution, to be completed by the person residing in Israel. the form must be filled out in clear handwriting and together with required documents in attachment.
Once completed and signed, the form must be sent to the International Affairs Division.

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Claim form to obtain a burial benefit from a Polish institution.
Once completed and signed, the form must be sent to the International Affairs Division.