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arrange Insurance
verification of
contract validity
Comprehensive health insurance for foreigners
Required and comprehensive coverage for obtaining a long term visa and residency permit for the Czech Republic
Information about insurance
Please enter the date in the format “dd/mm/yyyy” (dd = day, mm = month, yyyy = year - e.g. 25.07.2016)
The insurance must be arranged for at least 1 month but no longer than for 36 months.
Date of birth of the insured
Calendar
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Start date
RadDatePicker
Open the calendar popup.
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Duration of insurance
Spin Up
Spin Down
(in months)
Gender
male
female
Insurance validity:
The insurance is purchased for a limited time period. The premium is a one-time payment. The insurance is established as of the date on which the insurance contract is signed. Provided that the premium has been paid, the insurance is effective from 00:00am on the date specified in the insurance contract as the insurance start date. The premium is considered paid as of the date on which the entire sum of the premium was credited to the insurer’s account.
How much will you pay?
Premium
Discount voucher
recalculate premium
Discount voucher is not valid.
OK
Who will be insured?
Who doesn't need insurance:
First name
Last name
Other name
Birth date
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Birth place
Social security number or other number of the insured
Gender
male
female
Citizenship
select
Passport number
Passport valid from
RadDatePicker
Open the calendar popup.
Calendar
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Passport valid to
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
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Address of place of reported stay
Street
Number
City
ZipCode
Country
select
The mailing address is the same as the address of the insured person's reported residence.
E-mail
Phone number
The person arranging the insurance will be the insured
Information memorandum Personal data processing related to policy conclusion
back
payment
Czy na pewno chcesz przejść dalej bez wyrażenia zgody na przedłużenie terminu spłaty Twojej pożyczki w Vivus Finance?
PRZEJDŹ DALEJ BEZ WYRAŻANIA ZGODY
WYRAŻAM ZGODĘ I PRZECHODZĘ DALEJ
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##LOC[Cancel]##
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##LOC[Cancel]##
AXA ASSISTANCE CZ, s.r.o., Hvězdova 1689/2a, 140 00 Praha 4, Česká republika, IČO: 256 95 215.
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