Online statement of membership

Complete membership application

We will take care of the termination of your previous health insurance.

Mandatory fields are marked with a *:

dd/mm/yyyy

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.


 


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: 19/01/2021