Please fill out the registration form:

41.50^*

€

* For insured persons with a foreign nationality.

** Health insurance, highlights:

No deductible
Premium refund if you make no claims within an insurance year: up to two monthly premiums (e.g. €68 for insured persons up to 29 years of age)

*** Liability and accident insurance (Protection package):

The total contribution shown above applies to insured persons up to 29 years of age. Total contributions by age group:

Age	Months 1–24	From month 25
Up to 29 years	€41.50 / month	€64.50 / month
30 years and above	€57.50 / month	€80.50 / month

You will receive your free travel insurance within 48 hours after completing this form.

Your insurance confirmation can be verified digitally: embassies, authorities and policyholders can check its validity online. Verify your policy

Personal info ^*

Male

Female

Diverse

Undefined

Surname ^*

Given names ^*

Date of Birth ^*

Maiden name (surname at birth)^*

Place of Birth ^*

Country of Birth ^*

Nationality ^*

E-Mail ^*

Arrival Date in Germany ^*

Insurance period ^*

730 days

Passport ^*

Admission for the university/ Employment contract ^*

Personal photo ^*

I grant AF-MA, Reza Abadi, the broker mandate and broker authorisation (version 2026, German original). I here by provide my consent for this site to collect and process my personal data.And agree that i could be contacted by telephone or email. More about Data Protection at: Data Protection

Yes, I would like to apply for the Incoming Insurance.

Signature ^*

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Confirm Signature

Notice: Please Confirm your Signature before form Submitted