Incontinence grant – Commune de Mamer

Applicant's full name

First name

Name

Personnel number

Enter 13 numbers

Address (no. and street)

Postal code

Location

Phone

E-mail

Agreement number Page

Bank account number (IBAN)

Example: LU25 0019 1254 8746 1000

Bank (BIC code)

Example: BCEELULL

Bank account holder

First name

Name

People suffering from incontinence

First and last name

First name

Name

Personnel number

Enter 13 numbers

Medical certificate attesting to incontinence (on first application)

Drag & Drop Files, Choose Files to Upload

Location

Date

Applicant's signature

Clear Signature

RGPD Agreement

I consent to this site storing my submitted information so that they may respond to my request.

The data collected in this form is necessary for the processing of your file by the Communal Administration and, where applicable, its subcontractors. They are processed fairly and transparently in accordance with the General Data Protection Regulation (RGPD), and kept for the length of time necessary for this processing as well as the applicable legal archiving period. If you have any questions about the processing of personal data, you can contact the Data Protection Officer (DPO) at dpo@mamer.lu.