Form from Antwerp City Prison in the Begijnenstraat

Here is a form from the Antwerp City Prison in the Begijnenstraat. The form is a request for clothes and food that a prisoner can adress to a family member. There is no name or signature. The date is incomplete.

The form is known in the family as been filled-in by Avram. I have no reason to doubt about it.
The last digit of the year number is missing. So we know the form was dated January 16th, 194x. I'll try some hypothesis on the exact year. The paper being in three languages of which German which was not an official language in Belgium at that time it confirms that it is designed during German occupation in Antwerp. This leaves us with the years 1941 to 1944.

Avram is know to have been hidden during the latter part of the war in Brussels. I therefore would eliminate 1944.

We know from this document http://eisikandsura.blogspot.be/search/label/1943.01 that exactly on January 16th 1943 Charlote Docx got a document testifying her not being registered in the Jodenregister. Is that coïncidence or, if the prison form is indeed from 1943 would there be a relation between both ? We know that Charlotte has build up a whole file to testify her non-Jewish origin in order to save Avram.

A way to find more information is to check the prison registry, if they exist.