Thick smoke was seen billowing from the eighth floor of the building in the Linkeroever district, after the fire broke out just before 10:00 (08:00 GMT) on Wednesday.
Dramatic video showed a man clambering from his balcony through a neighbour’s window to escape the black smoke.
Police say more than 200 people live in the block and the bodies of a number of victims have already been found.
Resident Geert Dewulf told Belgian public TV how thick smoke had stopped him getting out of his flat: “We barricaded ourselves into our flat and waited on the balcony. The fire brigade came to rescue us from the balcony 10 minutes or so later with their ladder.”
Firefighters said they were going from flat to flat to search for possible victims, explaining that the smoke had spread quickly through the building making it harder to evacuate people.
Another man said his parents-in-law, one of them ex-mayor of Antwerp Bob Cools, had been successfully evacuated from the building and taken to hospital.
“We tried our utmost to save the cat but unfortunately in the end we were unable to,” he said.
Police said it was too early to identify the cause of the fire although witnesses told De Standaard newspaper that work was being carried out on the roof.
Antwerp fire brigade spokeswoman Marie de Clercq said it was a complex fire and the poor visibility and thick smoke in the building had made it difficult to put out.
Prime Minister Bart De Wever said his thoughts were with the victims and the evacuated residents of the “terrible fire” in Linkeroever.
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