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Request a certificate

The Brussels Fire Brigade intervened for you or one of your relatives and you would like to obtain a certificate of this intervention, fill out this form. Your request will be processed as soon as possible.

Completing the form takes about 5 minutes. If you have any questions, refer to the Questions/Answers section at the bottom of the page.

Operation information

Which certificate would you like?

The firefighters' report

The ambulance certificate

The ambulance certificate and medical form

Who are you applying for?

For myself

For a third party

What is the nature of the operation?

What is the date of the operation?

When did the operation take place?

In the morning

Afternoon

At night

Operation address

Post code and municipality

Example: 1000 Brussels. If the address is outside Belgium, please specify the country here.

Did the operation concern a building?

Your contact details

First name

Last name

Street and number

Post code and city

Phone

Third-party contact details

First name

Last name

Street and number

Post code and city

Example: 1000 Brussels. If the address is outside Belgium, please specify the country here.

Relationship with the applicant

For ambulance attestation requests, we require one or more supporting documents:

Copy of the front of the patient ID card
If the request is for a third party: a power of attorney with patient signature
If the request is made by a person related to the patient, add proof of that relationship
If the request is made by an external (Insurance, Lawyer...), add a proof of contract/ agreement with your client

Attach a file

Attach a supporting document

No file selected

Please attach a file (PDF, JPEG, or PNG).

How do you want to receive the certificate of operation?

What additional information would you like to add?

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Interv attachments

Request a certificate

FAQ