Declaration of accession

We offer you personalised support that is tailored to your needs.

If you would like to find out more about us, our services and the health programmes and bonus options we offer, do not hesitate to contact your local KKH asssitant:

English speaking hotline:
+49 511 80684 9303
We are at your service! Available weekdays from 9 am to 3 pm.
English E-Mailservice:
If you wish you can send an email to english@kkh.de and we will get in touch with you as sson as possible.

You can become a member directly:

General information about the member

Yes, I will become a member of KKH as of ...

Feld darf nicht leer sein

(acad. degree) Surname, First name*

Feld darf nicht leer sein

If applicable Birth name

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Date of birth - Tag / Monat / Jahr

/

Gender:

Female

Male

Diverse

Indeterminate

Place of birth*

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Nationality*

Feld darf nicht leer sein

Street, house number*

n

Postcode/ City/Town*

Tragen Sie bitte nur Nummern von 0 - 9 ein.

Nur Buchstaben erlaubt

Phone number*

Bitte geben Sie nur Zahlen ein

Email

Bitte geben Sie eine gültige Email-Adresse ein

Pension insurance number (RVNR)

Feld darf nicht leer sein

None available

Health insurance number (KVNR)

Feld darf nicht leer sein

None available

General information on insurance cover

Company number

Feld darf nicht leer sein

Name of employer/university/employment agency/job centre/pension provider

Feld darf nicht leer sein

Customer number (employment agency)/BG number (job centre)

Feld darf nicht leer sein

Street, house number

Feld darf nicht leer sein

Postcode

Feld darf nicht leer sein

City/Town

Feld darf nicht leer sein

Country/State

Feld darf nicht leer sein

Employed/unemployed/studying/retired since

Feld darf nicht leer sein

Annual gross pay (in €)

Feld darf nicht leer sein

I am married/related to the employer

Yes

No

Relationship with the employer

Husband/Wife

Father/Mother

Grandfather/Grandmother

I am a managing director and have a share in the company (company).

Yes

from ... to

Feld darf nicht leer sein

Name of current health insurance provider (private, statutory, foreign)

Feld darf nicht leer sein

Institute code of the statutory health insurance provider in Germany)

Feld darf nicht leer sein

Address of the above-mentioned health insurance provider

Feld darf nicht leer sein

International insurance number

Feld darf nicht leer sein

Additional Informations

Commenced with immigration from abroad

Did not commence with immigration from abroad

I would like to insure myself in Germany for the first time.

I come from an EU country.

I had statutory insurance abroad.

Additional information for students:

I am applying for the monthly contribution payment.

I am starting my first degree.

Additional information for pensioners:

I receive the following pension(s)

Orphan‘s pension

Old-age pension

Widow‘s/widower‘s pension

Reduced earning capacity pension

I receive an occupational pension or retirement benefit from:

Name of the provider

Feld darf nicht leer sein

Other income/insurance factors:

I have an additional occupation.

I receive a supplementary pension (e.g. orphan‘s pension, widow‘s pension, occupational pension or pension benefits).

I additionally receive a citizen‘s allowance (ALG II).

I study part-time.

I have a part-time self-employed occupation.

Name of employer/university/employment agency/job centre/pension provider

Feld darf nicht leer sein

Employed/unemployed/studying/self-employed/retired/VSB since

Feld darf nicht leer sein

Other:

I would like to insure family members free of charge.

Care insurance with the KKH: The registration includes the nursing care insurance with the KKH.

I am exempt from social nursing care insurance.

*Data protection

I have read the provisions relating to the protection of personal data. The provision of my personal data is optional. I agree that KKH will call me and advise me on the benefits of KKH, inform me about joining KKH and also store, process and use my personal data for these purposes. At any time I can revoke my consent by sending information to KKH, for example by telephone, e-mail or post.

Verbleibende Zeit bis der Captcha-Code erneuert wird: 60 Sekunden

A strong partner at your side!

We offer you personalised support that is tailored to your needs.