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Standard form: French (PDF, 40.82 KB) or Dutch (PDF, 45.71 KB)
However, Belgian consular missions can neither accept nor register the euthanasia declaration. Presently, only the Belgian municipalities can do so.
A duly completed euthanasia declaration is valid in Belgium, even if it has not been registered with a Belgian municipality.
More information on the conditions of validity of a duly completed euthanasia declaration in Belgium is available at the website of the FPS Public Health
It is uncertain whether this type of declaration would be valid abroad.