Self-Insuring Disease Part

Part of Occupational Illness for self-insurance companies (PEP)

In order to process the occupational disease report administratively, you must complete all the fields marked with an asterisk that make up the form and accept the data protection clause.

Remind you that you must send this completed form to the Mutual Fund within three business days.

You can also go to the occupational disease report by clicking on the link below

Occupational Disease Report for associated companies (PEP)

  1. Personal details
  2. Medical details
  3. Company-provided information
  4. Confirmation
Persona que realiza el trámite
*
*
*
*
Datos del trabajador
*
Contribution Account Code - C.C.C. It will be entered without spaces, slashes, periods or any other characters. Ex: 01123456742.
*
*
*
Indicate the province in which the worker's file is processed. If you do not know it, select the province of the C.C.C. in which the worker is registered.