Join now

Name
Initials
Gender	MaleFemale
Date of birth (dd/mm/yyyy)
Name of your higher education institution in the Netherlands
Address
Zipcode
City
E-mail address
Country of origin
Passport number
Commencement date of insurance (dd/mm/yyyy)
End date of insurance (dd/mm/yyyy)
Cover	EuropeWorld
Supplements:
Including medical expenses	YesNo
Special (winter) sports	YesNo
Are there any specifics HollandZorg needs to know regarding your application?
I acknowledge the content of the terms and conditions of the HollandZorg Student Insurance	Accept

your name

Receiver name

E-mailaddress receiver

Message:

I saw the following information on the HollandZorg website, and I’m sure it’ll be of interest to you too…"

Control code