Sigorta Form

1
Detected Location* This field is required.
2
Let's jump in! How many years you'd like?* This field is required.
1 Year
2 Year
3
Perfect! How old will you be this year? (1 year)* This field is required.
15 or younger
16 to 25
26 to 35
36 to 45
46 to 50
51 to 55
56 to 60
61 to 65
66 to 70
4
1 year
5
2 year
6
Perfect! How old will you be this year? (2 year)* This field is required.
15 or younger
16 to 25
26 to 35
36 to 45
46 to 50
51 to 55
56 to 60
61 to 65
66 to 70
7
Total in Turkish Lira: 1 year: {calculation43} and 2 year: {calculation44}
8
What's your full legal given name?Spell your name exactly as it's shown on your passport or ID card.
First Name
Middle Name
9
What's your full legal surname(s)Spell your name exactly as it's shown on your passport or ID card.
10
Document Type* This field is required.
Foreign Identity Number
Passport
11
What's your Foreign Identity Number?* This field is required.
12
What's your Passport Number?* This field is required.
13
What's your fathers first name?* This field is required.
14
What's your mothers first name?* This field is required.
15
Where were you born?* This field is required.Exactly as it's shown on your passport or ID card
16
What's your birthdate?* This field is required.
Date
Day
Month
Year
17
What's your nationality?* This field is required.
18
What's your gender? * This field is required.
MaleFemale
19
How tall are you?* This field is required.
< 40 cm
40 cm to 49 cm
40 cm to 49 cm
50 cm to 59 cm
50 cm to 59 cm
60 cm to 69 cm
60 cm to 69 cm
70 cm to 79 cm
70 cm to 79 cm
80 cm to 89 cm
80 cm to 89 cm
90 cm to 99 cm
90 cm to 99 cm
100 cm to 109 cm
100 cm to 109 cm
110 cm to 119 cm
110 cm to 119 cm
120 cm to 129 cm
120 cm to 129 cm
130 cm to 139 cm
130 cm to 139 cm
140 cm to 149 cm
140 cm to 149 cm
150 cm to 159 cm
150 cm to 159 cm
160 cm to 169 cm
160 cm to 169 cm
170 cm to 179 cm
170 cm to 179 cm
180 cm to 189 cm
180 cm to 189 cm
190 cm to 199 cm
190 cm to 199 cm
200 cm to 209 cm
200 cm to 209 cm
>= 210 cm
20
What's your weight?* This field is required.
< 10 kg
10 kg to 19 kg
10 kg to 19 kg
20 kg to 29 kg
20 kg to 29 kg
30 kg to 39 kg
30 kg to 39 kg
40 kg to 49 kg
40 kg to 49 kg
50 kg to 59 kg
50 kg to 59 kg
60 kg to 69 kg
60 kg to 69 kg
70 kg to 79 kg
70 kg to 79 kg
80 kg to 89 kg
80 kg to 89 kg
90 kg to 99 kg
90 kg to 99 kg
100 kg to 109 kg
100 kg to 109 kg
110 kg to 119 kg
110 kg to 119 kg
120 kg to 129 kg
120 kg to 129 kg
130 kg to 139 kg
130 kg to 139 kg
140 kg to 149 kg
140 kg to 149 kg
150 kg to 159 kg
150 kg to 159 kg
160 kg to 169 kg
160 kg to 169 kg
170 kg to 179 kg
170 kg to 179 kg
>= 180 kg
21
When would you like your policy to start?* This field is required.If it's a first application, enter the "Application Start Date" / If it's a renewal application enter the "Expiry Date of your Residence Permit"
Date
Day
Month
Year
22
Do you have any pre-existing diseases?* This field is required.
YESNO
23
Describe the disease in simple terms* This field is required.
24
What's your Turkish address?* This field is required.
Street Address
Street Address Line 2
City
State / Province
Zip Code
Turkey
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
25
Perfect, just a few quick questions left. And what's your mobile number?Please enter your phone number and will send you a 6-digit code to verify it.
26
Lastly, where should we email your policy to?* This field is required.
example@example.com
Confirm Email
27
Payment Method* This field is required.Credit Card (5% Commission) EFT (No Commission)
Credit Card
EFT
28
Total after adding 5%
29
Final total
30
Credit Card Payment* This field is required.Powered by Stripe
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Description
TRY
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First Name
Last Name
Credit Card Number
Security Code
Card Expiration
31
Here are the EFT account payment details.

Account holder: Ikamet Organizasyon Danismanlik Limited Sirketi

IBAN: TR04 0010 3000 0000 0033 2695 09

Payment Reference: {uniqueId}

hello@ikamet.com

+90 850 390 26 21
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