YEP INSURANCE ROTARY APPLICATION FORM Logo

  • BELGIUM YEP INSURANCE ONLINE APPLICATION FORM

    TO SUBSCRIBE THE YEP INSURANCE PACKAGE FOR YOUR UPCOMING INTERNATIONAL EXCHANGE STAY, PLEASE FILL IN THE FORM BELOW AND CONFIRM BY PAYING BY CREDIT CARD (PAYPAL). YOUR ASSISTANCE CARD WILL BE E-MAILED TO YOU.

  • You can only choose one product !

  • TRAVEL TYPE AND INSURANCE PREMIUM

  • prevnext( X )
          You are from a EU/EEA country, travelling to any worldwide country except to USA/CanadaPremium includes insurance taxes, commissions and web administration fees
          €413.30
            
          You are from a EU/EEA country, travelling to USA/CanadaPremium includes insurance taxes, commissions and web administration fees
          €836.10
            
          You are from an other than EU/EEA country, travelling to any EU/EEA countryPremium includes insurance taxes, commissions and web administration fees
          €413.30
            
          Total
          €0.00

          Email

          Billing Address

          Email

          Billing Address

          Email

          Billing Address

          Email

          Billing Address
          Klarna: Slice it requires a minimum payment amount for these countries:
          Germany: € 45, Finland and Australia: € 100

          Email

          Billing Address

          Email

          Billing Address

          Email

          Billing Address

        • TRAVELLER PERSONAL DATA

          Please enter your official and full name as it should appear on the insurance certificate.

        • HOME COUNTRY DATA

        • The home district insurance code is not correct !

        • DESTINATION COUNTRY DATA

        • STAY & INSURANCE DATA

        • Click here and read this first!

          X

          Please note

          We strongly suggest you to set your home return date to 364 days after your travel start date ! This has no effect on the premium you pay.

          This means an end date set to 2024.

        • The maximum insurance period is 12 months !

        • We suggest you set your home return date
          to 364 days after your travel start date !

        • Important message for subscribers from Argentina or Chile!

          Should the payment through credit card fail in the next step, you may wire the insurance premium of €413.30 + bank charges via bank transfer:

          • to the bank account of DAP Bruxelles Avenue Alphonse Demeur 23 1060 Saint-Gilles -Bruxelles Belgium
          • bank account number BE92 0689 0558 1923 (BIC: GKCCBEBB)
          • amount: €413.30 + bank charges to be borne by the person making the transfer (ask your bank what bank charges will apply and add these to the premium. We need to have the full amount € 413,30 on our account)
          • object of the communication: YEP Chile district 2160 or 2150 NAME and FIRST NAME of the insured person (traveller)

        • Please revise your data before submitting.
          When clicking on the submit button below, you will be redirected to the secure online payment page in order to finalize your subscription.

        • Legal information

          DAP Brussels n° BE0649 646 513 is responsible for the intermediation, and handling of the Insurance contracts and is accredited by the Belgian Financial and Markets Authority (FSMA) under the number 115309 A

          General conditions

        • Should be Empty: