Formular Kontaktformular Grenzgänger

Title*

Mrs

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First name

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Last name

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Address

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Postcode

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City

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Country

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Date of birth

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Phone (daytime)

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Mail

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Employer

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Company

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Address

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Postcode

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City

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Working status*

I work more than 8 hours per week

I work less than 8 hours per week

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Previous insurer

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Name of the previous insurer

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Valid residence permit

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Valid as of

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Since (year)

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Quotation for ÖKK EUROLINE (statutory health insurance)

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Delivery of the quote*

By Post

Via e-mail

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Comments

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Please indicate further persons with their name, first name and birth date under comments. All other data will be transferred directly.

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HIN encryption

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

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* Required field

The information provided will not be passed on to third parties. These data will only be stored and used to process the relevant matter.

By submitting the form, you confirm that you have acknowledged and accepted the Data protection notice.

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