HZMO 4.2.1 Life Certificate (Potvrda o životu): Fill Online

What is HZMO form 4.2.1 (life certificate)?

If you receive a pension from the Hrvatski zavod za mirovinsko osiguranje (HZMO, the Croatian Pension Insurance Institute) and live outside Croatia, HZMO asks you to prove from time to time that you are still alive. Tiskanica 4.2.1 is the bilingual Croatian-English life certificate (potvrda o životu) used for that.

Page 1 identifies you: HZMO reference and personal numbers, name, date and place of birth, address, and the identity card or passport you show. An authority then certifies it with a stamp and signature: a pension institution, a Croatian embassy or consulate, a state authority in your country of residence, or a notary. Page 2 is your own statement about employment and self-employment, plus sections for widows and widowers under 50 (remarriage) and for orphans (schooling).

FileIt explains each line in English, prints Croatian letters such as č, ć and đ correctly, ticks your answers in both the Croatian and the English sentence, and saves the filled PDF in your vault. FileIt does not send anything to HZMO: you take the form to the certifying authority, sign the statement by hand, and send it to HZMO.

Who fills it: A person living abroad who receives a Croatian pension from HZMO (including survivors' pensions for widows, widowers and orphans).
Certified by: A competent pension institution, a diplomatic or consular mission, a state authority in the country of residence, or a notary.
Signed: Page 1 is stamped and signed by the certifying authority; the page 2 statement is signed by hand by the pensioner.
Language: Croatian and English on the same form. German, French and Italian editions are forms 4.2.2 to 4.2.4.
Edition: Tiskanica 4.2.1; no edition date is printed on the form.

Who needs to fill out HZMO form 4.2.1 (life certificate)?

Pensioners living outside Croatia whose Croatian pension HZMO pays abroad.
Widows and widowers receiving a Croatian survivor's pension abroad, who also state whether they have married again if they are under 50.
Guardians or pensioners reporting on orphans who receive a survivor's pension, including whether each child is in education.
Family members helping an elderly relative abroad complete the paperwork.

When to use HZMO form 4.2.1 (life certificate)

Whenever HZMO asks you for a life certificate for payment abroad.
Before you visit the embassy, consulate, local authority or notary, so the details are ready to be certified.
If you prefer German, French or Italian alongside Croatian, HZMO publishes those editions as forms 4.2.2 to 4.2.4.

What you need before you start

HZMO's reference number (broj predmeta) and your personal number (osobni broj), from HZMO's letters.
Your name, date of birth, place and country of birth, and your current address.
A valid identity card or passport: its number, where and when it was issued, and its expiry date. Bring it to the certifying authority.
For the statement: whether you are employed or self-employed and compulsorily insured, and since when. If you are employed and insured, a suitable confirmation from your employer.
Widows and widowers under 50: whether and when you married again, and the marriage certificate if you did.
Orphans over 15: a certificate of attending school or university at the start of each school year or term, or a certificate from the employment service.

What’s on HZMO form 4.2.1 (life certificate)

The 2009 edition has 2 pages. FileIt asks for it in 5 parts:

Page 1: Life certificate (potvrda o životu)Pension beneficiary
Page 2: Statement (izjava)Pension beneficiary
Only for widows and widowers under 50 (samo za udovice i udovce mlađe od 50 godina)Pension beneficiary
Only for orphans (samo za djecu)Pension beneficiary
Signing the statementPension beneficiary

How to fill out HZMO form 4.2.1 (life certificate), step by step

1 Page 1 — Reference and personal numbers

Copy HZMO's case reference number (broj predmeta) and your personal number (osobni broj) from HZMO's letters. The large box at the top right is left blank.

2 Page 1 — Life certificate

'It is hereby certified that' your name and surname, born on your date of birth in your town and country of birth, whose address is your address, is alive. Then the identity card or passport number, where and when it was issued and when it expires. The place and date and the stamp and signature at the bottom are completed by the certifying authority.

3 Page 2 — Statement on employment

Tick whether you have or have not been employed since a given date, and whether you are or are not self-employed in an activity for which you are compulsorily insured. The statement is printed in Croatian and English; FileIt ticks both. If you are employed and insured, attach a confirmation from your employer.

4 Page 2 — Widows and widowers under 50, and orphans

Widows and widowers under 50 state whether they have married again and on what date, attaching the marriage certificate if so. For orphans, list each child's name and date of birth and whether the child is in education.

5 Page 2 — Place, date and signature

Write the place and date, and sign the statement by hand as the pension beneficiary. The form's note says the statement is completed and personally signed by the pensioner and sent to the address given.

Common mistakes to avoid

Signing page 1 yourself: that page is stamped and signed by the certifying authority.
Going to the authority with an expired identity card or passport.
Forgetting to sign the statement on page 2 by hand.
Leaving out the employer's confirmation when you are employed and insured, or the marriage certificate after remarrying.
Leaving out HZMO's reference or personal number, which HZMO needs to match the certificate to your pension.

After you fill it out

Print the PDF from FileIt and take it, with your identity card or passport, to a certifying authority: the pension institution of your country, a Croatian embassy or consulate, a state authority where you live, or a notary.

Sign the statement on page 2 by hand, attach any documents it asks for, and send the form to the address HZMO gave you.

Keep the filled form in your FileIt vault so next time you only need to check and update it.

Fill out HZMO form 4.2.1 (life certificate) online with FileIt

Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 34 fields in all. Your answers save as you go.
Check the live preview. Watch your answers land on the real Hrvatski zavod za mirovinsko osiguranje (HZMO), the Croatian Pension Insurance Institute form, and let FileIt do any worksheet arithmetic.
Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start HZMO form 4.2.1 (life certificate) now — it’s free

HZMO form 4.2.1 (life certificate): frequently asked questions

Who can certify the life certificate?

The form says a competent pension insurance institution, a diplomatic or consular mission, a state authority in the country of residence, or a public notary.

Is there a version in German, French or Italian?

Yes. HZMO publishes the same life certificate in Croatian with German, French and Italian text as forms 4.2.2, 4.2.3 and 4.2.4. Form 4.2.1 has Croatian and English text.

Do I have to fill in the widow and orphan sections?

Only if they apply. The remarriage question is only for widows and widowers under 50, and the orphan table only for survivor's pensions paid for children.

Can I sign it electronically?

No. The form says the statement is personally signed by the pension beneficiary, and page 1 is stamped and signed by the certifying authority, so FileIt prepares it for printing.

Does FileIt send the certificate to HZMO?

No. FileIt fills HZMO's official PDF. You have it certified, sign it and send it yourself.

Official sources

Blank form (PDF), published by Hrvatski zavod za mirovinsko osiguranje (HZMO), the Croatian Pension Insurance Institute: https://www.mirovinsko.hr/UserDocsImages/tiskanice/Tiskanica_br_4_2_1.pdf
Official instructions and guidance: https://www.mirovinsko.hr/hr/tiskanice-1098/1098
Edition shown on this page: Tiskanica 4.2.1 (no edition date printed; PDF of October 2009) (checked 2026-09-28).

FileIt is not affiliated with or endorsed by Hrvatski zavod za mirovinsko osiguranje (HZMO), the Croatian Pension Insurance Institute or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-09-28.