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  • English (UK)

  • 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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  • Students please see below:  

    If you are under 35 years and will be studying in Spain and have or can obtain a dated study certifcate please use the International Student policy application form located here

  • 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. Note UK £'s account are mostly acceptable. If you do not have a compatible SEPA account and anual payment by card or wire transfer will be applied. 

    You can check SEPA compatibilty here using your IBAN number. 

    Policies without a SEPA zone account require annual payment in full. If you do have 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. 

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  • 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: The policy holder needs to be the first insured, unless no cover is required.

    Or if the policy holder requires cover their information and health declaration is required here as the 1st insured below.

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    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
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      Pick a Date
    • Browse Files
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    • 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
    • Browse Files
      Cancel of

    • 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
    • Browse Files
      Cancel of

    • 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
    • Browse Files
      Cancel of

    • 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
    • Browse Files
      Cancel of

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

  • NOTE: If you urgently require your policy we recommend using the sign on screen now.

  • It is important that the signature is a a close as possible match to the one on the policy holder passport. If you're not happy with the result click clear and make another attempt.

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