Application: student health insurance

Personal Information

First name

Surname (required)

Address in Germany (if known): Street

E-Mail (required)

Date of birth

Place of birth

Nationality
---AfghanistanAlgeriaAngolaArgentinaAustriaAustraliaBangladeshBelarusBelgiumBoliviaBosnia and HerzegovinaBrazilBritainBulgariaCambodiaCameroonCanadaCentral African RepublicChadChinaColombiaCosta RicaCroatiathe Czech RepublicDemocratic Republic of the CongoDenmarkEcuadorEgyptEl SalvadorEnglandEstoniaEthiopiaFinlandFranceGermanyGhanaGreeceGuatemalaHollandHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaLaosLatviaLibyaLithuaniaMadagascarMalaysiaMaliMauritaniaMexicoMoroccoNamibiaNicaraguaNigerNigeriaNorwayOmanPakistanPanamaParaguayPeruThe PhilippinesPolandPortugalRepublic of the CongoRomaniaRussiaSaudi ArabiaScotlandSenegalSerbiaSlovakiaSomaliaSouth AfricaSpainSudanSwedenSwitzerlandSyriaThailandTunisiaTurkeyTurkmenistanUkraineThe United Arab EmiratesThe United StatesUruguayVietnamWalesZambiaZimbabwe

Gender
malefemaledivers

My Studies

Target degree
BachelorMasterPhD

University

Semester beginning
---Wintersemester 19/20Sommersemester 20Wintersemester 20/21Sommersemester 21Wintersemester 21/22Sommersemester 22

Subject

Number of semesters completed in the home country
---12345678910

Documents

acceptance letter

passport

I agree that insuranceME may forward my data to the AOK Baden-Württemberg.
I have read and accepted the data protection notice.*
The data is collected and processed, for the purposes of fulfilling our duties, pursuant to § 284 in conjunction with § 175 of the fifth volume of the Social Security Code [SGB V]. Your participation is required, pursuant to § 60 of the first volume of the Social Security Code [SGB I] and § 206 of the fifth volume of the Social Security Code [SGB V]. Please note: Without the necessary data, you cannot become a member of the AOK Baden-Württemberg. We may pass on your data to third-parties or service providers, who have been commissioned by us, within the framework of statutory obligations and notification competencies. For further reaching information on the processing of your data and your rights please refer to: www.aok-bw.de/datenschutzrechte. Upon request, we will gladly provide you with this information also in paper form. In case of further questions, please do not hesitate to contact AOK Baden-Württemberg, Presselstraße 19, 70191 Stuttgart or our data protection officer under: datenschutz@bw.aok.de. The indication of your telephone number and e-mail address is voluntary, however it facilitates our work to a great extent, in case of queries.

Consent to data use
For your security: The data are collected and processed to fulfil our duties in accordance with § 284 in conjunction with § 175 SGB V. Your participation is required according to § 60 SGB I and § 206 SGB V. Please note: Without the required data, you cannot become a member of the AOK Baden-Württemberg. Your data may be forwarded to third parties or to service providers who have been commissioned by us within the framework of legal obligations and notification duties. Further information about the processing of your data and your rights can be found at www.aok.de/bw/datenschutzrechte. Upon request, we will gladly provide you with this information in paper form too. If you have any questions, please contact AOK Baden-Württemberg, Presselstraße 19, 70191 Stuttgart or our data protection officer at datenschutz@bw.aok.de. Provision of your telephone numbers and the e-mail address is voluntary but makes it easier for us to work on queries.

I am interested in liability insurance

I am interested in private travel insurance that meets the VISA regulations

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