Back Ordinary A4 paper, portrait, 100% scale, no scaling, minimum margins. Two pages.
What this sheet is for
  1. Print both pages on ordinary A4 paper, at 100%.
  2. Measure the ruler printed at the bottom of each page. It must be exactly 100 mm. Otherwise your printer is resizing: turn off scaling and print again, otherwise the comparison means nothing.
  3. Put a real MOD 111 sheet on the printed page, against a window or a lamp, and line up the feed holes drawn in grey with the real holes.
  4. See whether the grey lines fall on the form's lines, and whether the values in black fall in the right boxes. Page 1 covers the top of the form, page 2 the bottom; they overlap by 15 mm.
  5. If everything is shifted by the same amount, measure it and enter it in the settings, “MOD 111 printers”: it is a one-figure correction, in width or in height. If a single box falls beside its place, report it to support (Help), saying which one.
MOD 111 alignment check, page 1 of 2 · form from 0 to 160 mm from the top · Leroy Zoé, 2026-10
Leroy Zoé
Mutualité de démonstration Nord
21.06.29-141.83
Rue de l'Exemple 1, 1000 Bruxelles
Leroy Zoé
Dr Martin, pédiatre
27
08
25
10000007000
26
09
25
11
09
25
10
09
27
76,74
Camille Renard, INAMI 6-00000-05-111, Rue de la Démonstration 1
1000 Bruxelles
26/10/2026
0123.456.749
06/10/2026
713311
13/10/2026
713311
Check ruler: from the first to the last line, exactly 100 mm
MOD 111 alignment check, page 2 of 2 · form from 145 to 304,8 mm from the top · Leroy Zoé, 2026-10
Leroy Zoé
Mutualité de démonstration Nord
21.06.29-141.83
Rue de l'Exemple 1, 1000 Bruxelles
Leroy Zoé
Dr Martin, pédiatre
27
08
25
10000007000
26
09
25
11
09
25
10
09
27
76,74
Camille Renard, INAMI 6-00000-05-111, Rue de la Démonstration 1
1000 Bruxelles
26/10/2026
0123.456.749
06/10/2026
713311
13/10/2026
713311
Check ruler: from the first to the last line, exactly 100 mm