SANITAS HEALTH INSURANCE STUDENT APPLICATION

Before proceeding please check you have the following:

If you're under 18 a parent or gaurdian should be the policy holder.
An image of your passport signed correctly for the policy holder / student.
If you have NIE's or TIE's please have digtial copies ready.
A SEPA bank account IBAN or Spanish account, without this payment will be required before cover documents are released.
If you don't have a correspondence address in Spain, you should use your place of study.
Breif knowledge of any current or past medical issues.

Then please complete all details, entering information for the policy holder first, and a health declaration for each beneficiary, including the policy holder if they require cover.

If somehow you've found your way here but need a price before applying, you can obtain that by following the link below.

Click here: ONLY If you need a price and don't wont to apply just yet.

Policy holder full name:*

Policy holder Email:*

If possible please use the same email you were quoted on.

Policy holder gender*

MaleFemale

Policy holder cell / mobile number:*

Holder cell / mobile num.*

Policy holder year of birth*

Policy holder month of birth*

Policy holder date of birth *

Policy holder Nationality:*

Passport / Spanish NIE status

I only have a national passportI have a passport and Spanish NIE

Policy holder passport Nº:*

Policy holder NIE :

Passport/s main photo pages for policy holder*

NIE / TIE Spanish document.

Stamped study certificate from your place of study showing dates for study period, course and your name. *

Select the plan required:*

Policy add-on´s

Traffic and work accidents + 2.50 € / Monthly

New policy or change to existing Sanitas policy*

New policyChange of policy

Student visa appointment*

I already have my visa application appointmentI do not have my visa application appointment

visa appointment date

Date

Policy start year *

Starting month for policy*

All policies start the 1st of the month

Policy end year

Note: Policy start and end dates maybe extended up to a maximum of 2 months either side of your study certificate.

Duration for policy*

Policies end the last day of the applicable calendar month. Policy end dates maybe extended up to a maximum of 2 months after your study certificate ends. For contracts of more than one year, you can extend your cover 90 days or before its end date.

Bank account details for Eurozone (SEPA) banks ONLY:

Note: Please leave blank, if you do not yet have an account in Spain or another European country. Note: UK £'s may pass the SEPA test but CANNOT be used. If you do not have a compatible SEPA account an anual payment by card or wire transfer will be applied.

You can check SEPA compatibilty here using your IBAN number.

Policies without a SEPA zone account require annual payment in full. If you do have a SEPA bank account we can apply Monthly, Quarterly or Bi-Annual payment.

If you do not have a useable bank account you will need to select Annual payment to proceed.

Payment frequency

No SEPA account (policy period or annual payment)Six MonthlyQuarterlyMonthly

International Euro Bank account

referred to as IBAN

SWIFT / BIC CODE

Required for International accounts

Address for health card and correspondence in Spain?*

Personal or correspondence address in SpainUniversity or study location address in Spain

POLICY HOLDERS PERSONAL ADDRESS

(Spanish address ONLY)

Note: If you do not have a Spanish residential address please use your place of study, as s Spanish address is required for this.

NOTE: If your address changes during the policy life and you settle in Barcelona / Valencia or the Spanish islands the premium charges are slightly more expensive, this premium change will be applied when the address is changed.

For apartments and urbanistations use: Block, Staircase, Floor, Flat as applicable.

POLICY HOLDERS STUDY ADDRESS

(Spanish address ONLY)

Note: Using your place of study to set up your ensures that your premium is calculated correctly. If at a later date you know have a residential address when can modify you policy inofrmation at that time.

NOTE: If you change your address and settle in Barcelona / Valencia or the Spanish islands the premium charges are slightly more expensive, this premium change will be applied when the address is changed.

For apartments and urbanistations use: Block, Staircase, Floor, Flat as applicable.

(NO Spanish address)

Selecting this option will require confirming by email that you do not have a Spanish address and wish to use our office address.

NOTE: If you finally settle in Barcelona / Valencia, Spanish islands the premium charges are slightly more expensive, this premium change will be applied when the address is changed.

University name

Street:

No.

Block:

Staircase:

Floor:

Flat:

Town/City:

Postcode:

Province:

Please answer the data protection question below Yes or No as you prefer.

1.*

YesNo

I agree to process my personal data to promote Sanitas or third-party company products and services, including marketing communications via electronic means or equivalent sent by Sanitas, even if I do not take out the insurance.

2.*

YesNo

I agree to transfer and process my personal data by Sanitas group companies for scientific and / or statistical research purposes and marketing purposes, in addition to third-party collaborating companies identified in Additional Information, in order to send me marketing information related to financial products and services, insurance, social and healthcare and/ or health or wellness products and services,including marketing communications via electronic means

3.*

YesNo

I agree to process my personal data for the purpose of Sanitas analysing my interests and needs based on the data I provide, including, but not limited to, my health data, personal data generated as a consequence of a service provided by Sanitas or that Sanitas has obtained via other means; this processing may include automated decision making.

STUDENT HEALTH INSURANCE

INSURED APPLICANTS