Change address

Insurance no.*

First name*

Last name*

E-mail*

Your previous address

Address*

Postcode*

City*

Telephone

Address change for*

Your new address

Address*

Postcode*

City*

Telephone

Change valid as of*

Reason for change of address* Change of residence New address during week New correspondence address

Have your bank account / postal account details also changed as a consequence of your move? If so, please state your new IBAN no. and the account holder here.

IBAN-no.

Account holder

Comments

HIN encryption I would like to receive any documents via HIN-encrypted message.

* Required field

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Environmental levies on premium invoices

Changing or terminating health insurance

Change address

Your previous address

Your new address

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