Aanvraag crisis-overbruggingsrecht gedwongen sluiting oktober –

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Aanvraag crisis-ov=
erbruggingsrecht gedwongen sluiting oktober – december

Naam
De Coster

Voornaam
Stefan

Rijksregisternummer
73092235103

Postcode
9570

E-mailadres
info@stefandecoster.be

E-mailadres boekhouder (optioneel)
info@stefandecoster.be

Heb je =C3=A9=C3=A9n of meerdere personen, andere d=
an jezelf, ten laste (volgens het ziekenfonds)?

Nee

Bankrekeningnummer (IBAN)
BE36731013600381

Ondernemingsnummer (zonder spaties of punten)
0646865482

Ondernemingsnummers van andere ondernemingen waarin=
je actief bent:

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Kruis aan wat voor jou van toepassing is:
Oktober, November, December

Oktober
=20

November
=20

December
=20

Leg uit waarom je activiteit getroffen is:=

Mogen geen eten ter plaatse serveren

Ontvang je een vervangingsinkomen voor de maand okt=
ober (werkloosheidsuitkering, pensioen, arbeidsongeschiktheids- of invalidi=
teitsuitkering,=E2=80=A6)

Nee

Brutobedrag:
=20

Ontvang je een vervangingsinkomen voor de maand nov=
ember (werkloosheidsuitkering, pensioen, arbeidsongeschiktheids- of invalid=
iteitsuitkering,=E2=80=A6)

Nee

Brutobedrag
=20

Ontvang je een vervangingsinkomen voor de maand dec=
ember (werkloosheidsuitkering, pensioen, arbeidsongeschiktheids- of invalid=
iteitsuitkering,=E2=80=A6)

Nee

Brutobedrag
=20

Ik verklaar dat ik dit formulier naar waarheid inge=
vuld heb. Ik ben mij ervan bewust dat mijn verklaring onderhevig is aan con=
troles en dat ik de nodige bewijsstukken over de stopzetting kan voorleggen=
.

true

Ik ben op de hoogte dat elke valse of onvolledige v=
erklaring kan leiden tot de terugvordering van de ten onrechte uitbetaalde =
uitkeringen en tot gerechtelijke vervolging.=C2=A0

true

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