Online enrollment 3 - Buendiaseguros

Online enrollment

Welcome to the secure area for enrolling in DKV health insurance

Complete your enrollment in 6 steps and start enjoying your insurance. We will guide you through the entire process, indicating the information you need to provide in case you have any questions.

Fields marked with a red asterisk must be filled in mandatory.

Holder Policy
Insured 1
Health Question Insured 1
Insured 2 and 3
Health Question Insured 2 and 3
Bank Account

Phone

Start date *

Name and Surname *

Date of Birth *

ID number *

Nationality *

Address *

Post Code *

Phone (Spanish phone) *

Email *

INSURED 1

Name and surname *

Date of Birth *

ID Number *

Nacionality *

Health Question Insured 1

Weight (Kg) *

Height (cm) *

Do you have, or have you had, any kind of illness, accident, congenital defect, hereditary family illness, painfull joints, or any symptoms or pain? (give details) *

Have you recived, are you receiving, or are you about to recive any kind or surgical, medical, pharmaceutical, rehabilitating or dietetic treatment (eg. hypertension diet)? (give details of treatment, cause and dates) *

Have you ever been, or are about to be, admitted to hospital? (Give details of causes and dates) *

Have you had, or are you about to have, any diagnostic test? (give details of type of test, motive, result and date) *

Insured 2

Name and Surname

Date of Birth

ID Number

Nacionality

Insured 3

Name and Surname 3

Date of Birth 3

ID Number 3

Nacionality 3

Health Question Insured 2

Weight (Kg) 2

Height (cm) 2

Do you have, or have you had, any kind of illness, accident, congenital defect, hereditary family illness, painfull joints, or any symptoms or pain? (give details)

Have you ever been, or are about to be, admitted to hospital? (Give details of causes and dates)

Have you had, or are you about to have, any diagnostic test? (give details of type of test, motive, result and date)

Health Question Insured 3

Weight (Kg) 3

Height (cm) 3

Insured 3. Do you have, or have you had, any kind of illness, accident, congenital defect, hereditary family illness, painfull joints, or any symptoms or pain? (give details)

Insured 3. Have you recived, are you receiving, or are you about to recive any kind or surgical, medical, pharmaceutical, rehabilitating or dietetic treatment (eg. hypertension diet)? (give details of treatment, cause and dates)

Insured 3. Have you ever been, or are about to be, admitted to hospital? (Give details of causes and dates)

Insured 3. Have you had, or are you about to have, any diagnostic test? (give details of type of test, motive, result and date)

Bank Account

Payment period *

Bank Account *