Stichting Scheepvaart
Health insurance application AZVZ

You may fill in the Health Insurance application below to register with AZVZ Insurance. Your personal data are handled with strict confidentiality.

If you do not want to apply online you may also download the application form as a pdf.

1. Policy holder
2. Choice of insurance

* Only in combination with Standard package.

3. Date of entry
4. Collectivity
5. Payment of contribution
6. Authorization

Please Note! lf you don't have the Dutch nationality, please enclose a copy of a valid passport.

lf you are a resident of a Member State of the European Economic Area, on request we will send you an E106 European form.
E 106: Certificate of entitlement to sickness and maternity insurance benefits for persons residing in a country other than the competent country. With this form you and your family members can register at the health insurance authorities in your country of residence.

With this form you and your family members can register at the health insurance authorities in your country of residence.

7. Letter of agreement
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