• SANITAS HEALTH INSURANCE

    APPLICATION FORM

  • Policy type & holder details

    If the policy holder is insured they should be entered as insured Nº1
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  • Select optional policy add-on's below: 

    Note: Price's quoted will most likely not include any of these of these add-on's 

  • Bank account details for Eurozone (SEPA) banks ONLY:

    Note: Please leave blank, if you do not yet have an account in Spain or another European country. Anual payment by card or wire transfer will be applied. 

    Policies without a SEPA zone account require annual payment in full. If you do have European (SEPA) bank account we can apply Monthly, Quarterly or Bi-Annual payment.

    If you do not have a useable bank account please select Annual payment to proceed. 

  • Passport copies for policy holder and all applicants:

    Please scan or photo the principal page/s of your passport (the main page inc. the photo ID and passport Nº and signature etc) and upload all using the browse option below.  NOTE: VISA stamped pages etc are note required. 

  • Browse Files
    Cancel of

  • POLICY HOLDER ADDRESS

    (Spanish address ONLY)

    Note: Please leave blank, if you do not yet have a Spanish address we will use our office address until you have one. 

    For apartments and urbanistations use: Block, Staircase, Floor, Flat as applicable. 

  • Please answer the data protection question below Yes or No as you prefer.

  • 1.

    I agree to process my personal data to promote Sanitas or third-party company products and services, including marketing communications via electronic means or equivalent sent by Sanitas, even if I do not take out the insurance.

  • 2.

    I agree to transfer and process my personal data by Sanitas group companies for scientific and / or statistical research purposes and marketing purposes, in addition to third-party collaborating companies identified in Additional Information, in order to send me marketing information related to financial products and services, insurance, social and healthcare and/ or health or wellness products and services,including marketing communications via electronic means

  • 3.

    I agree to process my personal data for the purpose of Sanitas analysing my interests and needs based on the data I provide, including, but not limited to, my health data, personal data generated as a consequence of a service provided by Sanitas or that Sanitas has obtained via other means; this processing may include automated decision making.

  • INSURED APPLICANT Nº 1

    Health questionnaire

  • Note: If policy holder requires health their information and health declaration is required here.

  •  -  -
    Pick a Date

  • Additional add-ons that can be purchased for each of the insured (only valid if compatible with the product)

  • I hereby declare that I have answered all of the questions in this application form truthfully and I acknowledge that I have received the Information Prior to taking out the insurance contained in this application form and in the Information about the insurance product document associated to the application form.

    • Click to add 2nd Insured  

    • Contine past this point for 2 or more insured persons. 

    • INSURED APPLICANT Nº 2

      Health questionnaire - Please complete all boxes for this applicant
    •  -  -
      Pick a Date

    • Additional add-ons that can be purchased for each of the insured (only valid if compatible with the product)

    • Click to add 3rd insured  

    • Page only required when 3 persons are insured

    • INSURED APPLICANT Nº 3

      Health questionnaire - Please complete all boxes for this applicant
    •  -  -
      Pick a Date

    • Additional add-ons that can be purchased for each of the insured (only valid if compatible with the product)

    • Click to add 4th insured  

    • Page only required when 4 persons are insured

    •  -  -
      Pick a Date

    • Additional add-ons that can be purchased for each of the insured (only valid if compatible with the product)

    • Click to add 5th insured  

    • Page only required when 5 persons are insured

    •  -  -
      Pick a Date

    • Additional add-ons that can be purchased for each of the insured (only valid if compatible with the product)

    • Click to add 6th insured  

    • Page only required when 6 persons are insured

    •  -  -
      Pick a Date

    • Additional add-ons that can be purchased for each of the insured (only valid if compatible with the product)

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