YABANCI UYRUKLU SAĞLIK SİGORTASI BAŞVURU FORMU
PRIVATE HEALTH INSURANCE APPLICATION FORM
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VERGİ NO VEYA TC /T.R. INDENTITY NO
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PASAPORT NO / PASSPORT NO
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SİGORTALI ADI VE SOYADI: NAME /SURNAME
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BABA ADI/ FATHER NAME
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DOĞUM YERİ/ PLACE OF BIRTH
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ANNE ADI / MOTHER NAME
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DOĞUM TARİHİ / DATE OF BIRTH
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CİNSİYET - GENDER
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ADRES / ADDRESS
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TELEFON / PHONE NO
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IF YOU CAN’T CONNECT WITH US PHONE NUMBER / ULAŞILAMAMASI DURUMUNDA TELEFON NO
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FACEBOOK ACCOUNT / FACEBOOK HESABI
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GEÇİRMİŞ OLDUĞUNUZ AMELİYAT YADA HASTALIK VAR MI? EVET İSE DETAY BİLGİSİ / IF YOU HAVE ANY DISEASE OR OPERATION THAT YOU HAD?IF YES, WHAT ARE THE DETAILS
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GEÇMİŞTEN GELEN BEYAN ETMEDİĞİM AMELİYAT VE RAHATSIZLIK YOKTUR./ THERE İS NO DISEASE OR NO OPERATION WHICH I NON DECLARATION, THAT COMES FROM PAST.
İŞ BU SİGORTA POLİÇESİ AŞAĞIDA YAZILI 2 SEBEPTEN BİRİNİN GERÇEKLEŞMESİ DIŞINDA HİÇBİR SEBEPLE İPTAL EDİLEMEYECEĞİNİ KABUL EDİYORUM./HERE OF INSURANCE POLICY,I ACCEPT THAT POLICY CAN NOT BE CANCELED FOR ANY REASON WITH THE EXCEPTION OF TWO REASONS WRITTEN BELOW.
1. İKAMET İZİN SÜRESİNİN KAPSAYAN YENİ BİR ÖZEL SAĞLIK SİGORTASI SÖZLEŞMESİNİN ŞİRKETE İBRAZINDA /UPON PRESENTATİON OF THE NEW PRIVATE HEALTH INSURANCE AGREEMENT TO THE COMPANY WHICH COVER RESİDENCE PERMİT TİME
2. 5510 SAYILI SOSYAL SİGORTA VE GENEL SAĞLIK SİGORTASI KANUNU GEREĞİNCE GENEL SAĞLIK SİGORTASI KAPSAMINA DAHİL OLUNDUĞUNU GÖSTERİR BELGE İBRAZINDA / 5510 NUMBERED SOCIAL INSURANCE AND GENERAL HEALTH INSURANCE BY LAW, UPON PRESENTATION OF THE DOCUMENT WHICH SHOWS INCLUSION OF THE GENERAL HEALTH INSURANCE COVERAGE.
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