Formular 1 Antragsstrecke public health

Questionnaire

Personal Information

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General Information

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Co-insurance for Dependents:

Your Public Health Insurance

Occupation:

Annual Gross Income:

Number of Children:

Age:

Insurance company:

Techniker Krankenkasse

Personal Information

Your First Name: Your Last Name:

Your Birthdate:

Your Nationality:

Do you have a German address?

Yes

If you do not currently have a German address, we will use your employer's c/o address instead.
All documents will be sent to this address, as well as to you by e-mail. As soon as you have an address in Germany, you can inform TK of this by e-mail.

Your Gender:

Male

Female

Your Email Address:

In which country did you live before you came to Germany?

Did you have Health Insurance coverage before you came to Germany?

Yes

Shall we apply for your TK Health Insurance card?
If yes, please upload a portait photo of yourself (neutral background, no headwear or sunglasses).

Please fill in all required fields.

Your Public Health Insurance

Personal Information

Employer's Information