Application for disabled child

The application form for the granting of this benefit and the medical form which must be completed by a doctor can be requested in writing from the Children's Fund by completing this form.

You will receive the application form by mail to the specified address.

Fields marked with an asterisk (*) are mandatory.

* Mandatory fields

Personal data protection
Your personal information collected in this form is subject to processing by the relevant agency in order to complete your request.
This information is kept by the agency for the period of time necessary to complete its processing.
The recipients of your data are agencies authorized to process your request. To find out the recipients of the data mentioned in this form, please contact the relevant agency dealing with your request.
In accordance with Regulation (EU) 2016/679 on the protection of individuals with regard to the processing of personal data and the free movement of such data, you have the right to access, rectify, and if necessary, erase information concerning you. You also have the right to withdraw your consent at any time.
In addition, and except those cases when the processing of your data is compulsory, you can oppose it for legitimate reasons.
If you wish to exercise these rights and/or obtain communication of your information, please contact the relevant agency using the contact details indicated in the form. You also have the possibility to lodge a complaint with the National Commission for Data Protection, headquartered at 1 Avenue du Rock'n'Roll, L-4361 Esch-sur-Alzette.
By continuing, you agree to have your personal data processed as part of your request.

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