Private Health Insurance Personal Information

Private Health Insurance - Personal Information

Personal Information

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Customize your coverage

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Dependents coverage

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Health status

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Occupation in Germany

Your private health insurance application

Insurance provider: Hallesche

Birth year

No Data

Yearly income

No Data

Occupation

No Data

Selected plan

No Data

per month

Personal information

First name:

Last name:

Birthdate:

Your gender:

Male

Female

Your nationality:

Marital status:

Do you have a German address?

Yes

Postal code:

City:

Street:

House number:

If you do not currently have a German address, we will temporarily use our company's c/o address. Please inform us of your German address as soon as you move to Germany.

How long do you plan to stay in Germany?

Your personal email address:

Your personal phone number:

Country of previous residence:

Did you have a previous insurance coverage during the last 12 months?

Yes

Name of previous health insurance company:

Insurance was:

Public

Private

Insurance period (MM/YYYY):

From:

To:

Please fill in all required fields.