Contact form

Mirja here!
Before we start, I’d love to get to know you!

First name

Family Name

Date of Birth

I'm looking for …

Health insurance

Occupational disability insurance

Both

Thanks {c_first_name}!
Can you also tell us a little about the following …

I need insurance for:

Myself

My partner

My kids

Marital Status

Single

Single (with kid/s)

Married

Divorced

Widowed

E-Mail

Got it, {c_first_name}. Thanks!
Could you tell us more about your occupation and income?

Job Title

Employer

Status

Employee (gross ⩾ 66.600 €/year)

Employee (gross < 66.600 €/year)

Mini-Jobber (gross ⩽ 450 €/month)

Freelancer (before tax ⩾ 45.000 €)

Freelancer (before tax < 45.000 €)

Student

PhD

Unemployed

Retired

Start of current Employment

Do you have a fixed-term employment contract?

No, unlimited

Yes (> 8 months)

Yes (< 8 months)

How long do you expect to live in Germany?

Less than one year

A couple of years

Indefinitely

Not sure, but I will definitely not retire in Germany

Just a few more questions, {c_first_name}.
Please hang in there!

Relocation

When did you move to Germany?

Less than two months ago

More than 2 months ago

More than 12 months ago

More than 24 months ago

I will relocate soon

Registration ("Anmeldung") (optional)

Select a file …

Allowed file types: pdf jpg jpeg png

Prior residence in …

Visa status

Unlimited

Limited

Passport

EU-Citizen

Non-EU-Citizen

Dual Citizenship

Passport from …

Select multiple countries by holding down the CTRL / CMD key.

Thanks, {c_first_name}!
Is there anything else you’d like to share?

My request is …

Not urgent at all

Slightly urgent

Very urgent

Preexisting conditions

I need coverage for preexisting conditions (e.g. asthma, diabetes or mental illness)

Tell us more

Thank you so much, {c_first_name}!
What’s the best way to reach you besides email?

Please use the international format with a leading plus-sign (+).

Skype

LinkedIn URL

Optional: Enter the full URL to your LinkedIn profile

Phone

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How did you hear about us?

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