Private Health Insurance Personal Information

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

Private Health Insurance

Personal information

Please enter your personal information to continue your private health insurance application.

Your details

First name:

Last name:

Birthdate:

Your gender:

Male

Female

Your nationality:

Marital status:

Contact and residence details

Your personal email address:

Your personal phone number:

Country of previous residence:

How long do you plan to stay in Germany?

Address information

Do you have a German address?

Yes

No

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.

Previous insurance coverage

Did you have a previous insurance coverage during the last 12 months (also abroad)?

Yes

No

Name of previous health insurance company:

Insurance was:

Public

Private

Insurance period from (MM/YYYY):

Insurance period to (MM/YYYY):

Please fill in all required fields.