OmnibusBCN - Salud

Insured Declaration

Number of Insured

Course / Program duration, max. 12 months

Date of Birth Policyholder

Products

from 20,36 €

Assistance

Medical cover exclusively for emergencies or supervening illnesses and accidents.
Sin períodos de carencia.
Sin copagos.
Repatriation in case of death and serious illness or serious accident.
Accident insurance in case of death: 6000 €.

* for emergencies or supervening illnesses and accidents

from 34,95 €

Health Insurance

* coverage of 100%

Details of Coverage

Start Month

Start Year

Student / Policyholder Details

Name

Passport/NIE

First Surname

Second Surname

Date of Birth

Type of Road

Address

Postal Code

City

State

Datos de Familiar/es

Datos Primer Familiar

Name

Passport/NIE

First Surname

Second Surname

Date of Birth

Datos Segundo Familiar

Name

Passport/NIE

First Surname

Second Surname

Date of Birth

Datos Tercer Familiar

Name

Passport/NIE

First Surname

Second Surname

Date of Birth

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