Online statement of membership

1) Complete membership application

2) Terminate previous health insurance

Quick and easy with our termination form template.

3) Send confirmation of termination of previous health insurance to IKK Südwest

As soon as we receive confirmation of termination of your previous health insurance and your completed statement membership, we will issue you a membership certificate.

Mandatory fields are marked with a *:


If you do not know your pension insurance number, please provide your country/place of birth and your name at birth.



I have dependents who should be included in IKK Südwest’s insurance without contributions:


If we need any further information, we will contact you directly.

Declaration of consent*

I consent to IKK Südwest storing and using my data to provide me with information and advice in writing (including email) or by telephone. My data will of course be protected and treated confidentially. It will not be passed on to third parties. I may limit or cancel this declaration of consent at any time.


Citizens Relief Act*

I consent to IKK Südwest communicating the size of my contributions to the tax authorities via data transfer in accordance with the Citizens Relief Act, and thus requesting the required tax ID from the Federal Central Tax Office if necessary. Contributions to health and nursing care insurance may not be taken into account as a tax-reducing factor without consent when calculating income tax.


Processing of personal data

In order to use this service, you must consent to our privacy policy and accept our terms and conditions of use.

Date: 19/10/2019