Grant Health Insurance

Details of the applicant and the insured person

E-mail address

Data protection notice

I agree to receive my insurance documents as well as further information on my insurance contract by e-mail, and have taken note of the privacy notice.

Fellow travelers

You can conveniently add your family members via our Self Service Portal after receiving the provisional insurance.

Gender

Title

First name

Family name

Telephone number

Nationality

Passport number

Do you know your address in Germany?

Yes

No

Street and house number

c/o

Postal code

City

Do you already have a German bank account?

Yes

No

We require a SEPA direct debit mandate from you authorizing DR-WALTER to collect your monthly health insurance premiums from your account.
If you do not yet have a German bank account, you can provide us with the details after your entry. Once you have completed the process, you will receive an email with a link to your personal self-service portal.

Account holder

IBAN

Signature of the account holder

Sign in the field below for the SEPA direct debit mandate.

Grant Health Insurance

Conclusion