After you have filled out and sent the online form, you will receive a printable declaration page/confirmation of coverage (Versicherungsschein) via email, assuming all provided information is complete and valid and you have been approved for coverage. In most cases you can already use this to apply for or extend your visa or residency permit.
You will find help regarding the necessary details you are asked to provide by clicking on the
You will find help regarding the necessary details you are asked to provide by clicking on ? the next to the respective fields.
next to the respective fields.
Internet Explorer 6.0+
Click the Tools menu.
Select Internet Options.
Click the Security tab.
Click the Custom Level button.
Scroll down until you see the 'Scripting' section. Select the 'Enable' radio button for 'Active Scripting.'
Click the OK button.
If you see a confirmation window, click the Yes button.
Click the Tools menu.
Click the Content tab.
Click the OK button.
The policyholder / contract holder is the person purchasing this policy for him/herself or for another person.
If the policyholder’s name is not on the mailbox, please enter the recipient's name in the field, c/o.
If the group to be insured is a family with a maximum of 2 adults until their 65st birthday and children until their 21st birthday, please click on the family rate box above.
Please enter only checking accounts from the SEPA area, because we can only carry out direct debit transactions in these countries.In the case of the SEPA direct debit method, the premiums due will be collected shortly before the start of coverage to which the premiums relate. A few days before we will send you a pre-notification. If you choose for payment at once, the entire insurance premium will be collected at the beginning of the period of coverage.
In order for us to be able to debit the amount payable directly from the account provided, we need the first and last names of the account holder as well as a SEPA direct debit mandate. This mandate will be securely saved within our system as a PDF file, together with your payment details. A copy of your mandate as a PDF document has been sent to the email address you specified. Please provide the following information of the account holder:
As part of the SEPA changeover enacted by the EU, you must state your BIC instead of your bank code and your IBAN instead of the account number. These can be found, depending on the bank, on your debit card or on your bank account statement. If you are not able to find the BIC and IBAN, you can contact us at +49 228 97735-44, +49 228 97735-11 or +49 228 97735-33.In order for us to be able to debit the amount payable directly from the account provided, we need a SEPA direct debit mandate. This mandate will be securely saved within our system as a PDF file together with your payment details. A copy of your mandate as a PDF document has been sent to the email address you specified.
Die Versicherungsprämie kann erst nach der Auswahl des Versicherungsbeginns angezeigt werden.
Tipp for qq-user:To be sure that you receive all documents, please fill in another (not qq-)e-mail in the field for the second e-mail
The fields marked with an * asterisk are not required to take out a policy, but the information provided makes it easier for us to contact you. You will not receive any unsolicited advertising material via email, and we will not forward your information on to any third parties.
By clicking on the adjoining field you confirm that you have read, understood and agreed to the following conditions. I confirm that I have provided all information fully, carefully and correctly. In addition, I am authorized to make all declarations/disclosures and am fully informed to make them. If this is not the case at any point, I have indicated this. At the same time, by clicking here you are confirming that you printed and / or downloaded the following terms and conditions/documents before sending your application:
By clicking on the adjoining field you confirm that you have read, understood and agreed to the following conditions At the same time, by clicking here you are confirming that you printed and / or downloaded the following terms and conditions/documents before sending your application: