statutory health insurance AOK Application AOK Antrag EN 1. Personal Information I am*I amIn trainingIn studyEmployedIndependentOtherwise insuredTitle*TitleMs.Mr.DiverseVorname* First Nachname* Last Citizenship* Date of birth (DD.MM.YYYY)*Note: Students over the age of 30 cannot take out insurance with the AOK. Employees can take out insurance with the AOK or switch to the AOK regardless of their age.DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Last name at birth* Place of birth* Country of birth* Address in Germany* Street Address City ZIP / Postal Code E-Mail* Children* Yes No 2. Study DetailsUniversity in Germany* Start of study* Winter semester Summer semester Year of start of study* 2. Employer detailsStart of employment*Start of employment DD dot MM dot YYYY Employer*Employer Employer addres in Germany* Street Address City ZIP / Postal Code 3. Insurance DetailsI am/was last insured in/with aI am/was last insured in/with aAbroad (not possible for employees)Statutory health insurance in GermanyPrivate health insurance in GermanyName of the statutory health insurance*Name of the statutory health insurance I have been exempt from student insurance obligations*I have been exempt from student insurance obligations Yes No Unfortunately, it is not possible to switch to the AOK in your case. I am working as a self-employed person, employee or trainee during my studies?*I am working as a self-employed person, employee or trainee during my studies? Yes No Weekly no. of working hours*Weekly no. of working hours under 20 h over 20 h 4. Dependents (Spouse/Civil Partner/Children)I do not have any dependents/my dependents already have statutory or private insurance.*I do not have any dependents/my dependents already have statutory or private insurance. Yes No I want to co-insure my dependents free of charge. Please send me a corresponding application.*I want to co-insure my dependents free of charge. Please send me a corresponding application. Yes No 5. Data Protection & Proxy All information on data processing can be found in our data protection regulations. Privacy* With my signature, I authorise MAWISTA GmbH to transmit the application data to the statutory health insurance fund. I authorise MAWISTA GmbH to receive the social data relating to my membership. I agree that the chosen health insurance fund may transmit the identification data and information as to whether and from when membership has been established for billing purposes. HiddenDate Signature of applicant/legal representative* Reset signature Signature locked. Reset to sign again CAPTCHANameThis field is for validation purposes and should be left unchanged.
