Become a member

Step 1: Personal details

Gender

First name*

Surname*

Address*

Post code & city*

Telephone*

Email*

Date of birth*

Name at birth

Place of birth*

Country of birth

Nationality

Marital status

Step 2: Account details for refunding benefits

IBAN

Step 3: Previous health insurance

Previous health insurance*

Would you like to have other family members insured as well?*Would you like to have other family members insured as well?

Yes *

No *

Step 4: Employer (or university, training organisation etc.)

Your employer * (or university, training company, etc.)*

Organisation number

Contact person within the company

Telephone

Company Address*

Post code & city*

Employs me as

Place of employment

** Required for registration. Please ask your HR department for the company number.

Step 5: Data protection

Data protection**

Data protection*

The data you enter will only be collected, processed and used to process your request within the framework of the data protection regulations. A transfer to third parties does not take place.

*Mandatory field