TK Formulaire de demande en ligne Techniker Krankenkasse 1Personal information2Work / Study details3Previous insurance / Family details datetodayCe champ est masqué lorsque l‘on voit le formulaire.providerTKCe champ est masqué lorsque l‘on voit le formulaire.refexpatsprogedo-berlinprogedo-hamburgsympatmereloneemoveto-berlinCe champ est masqué lorsque l‘on voit le formulaire.partnerStartI would like to insure myself as*EmployeeStudentWhen do you want your TK coverage to start?* JJ . MM . AAAA This is / must be the date you start working (as is your work contract) or the start date of your studies. The date can be in the past.Personal informationName* Prénom Nom Date of birth* JJ . MM . AAAA Is your date of birth correct?Gender* Male Female Diverse AddressIs your employer: Airbus OR Kuehne+Nagel* Yes No If you have no address in Germany and your employer is Airbus, please answer the next question with yes and enter the following address. Your post from TK will then be sent to PROGEDO Hamburg. Address Line 1: Simon-von-Utrecht-Str. 1 Address Line 2: c/o PROGEDO Hamburg ZIP: 20359 City: HamburgDo you have a german address?* Yes No We will send your health insurance confirmation to your employer.Is your name on the mailbox?* Yes No Please enter in the line « Address Line 2 » the name which is written on the mailbox and insert a « c/o » in front of the name. Example: « c/o Name » or « c/o Company Name »Do you currently live in a boarding house?* Yes No Example for VISION Apartments Address Line 1: Otto-Braun-Str. 67 Address Line 2: c/o VISION Apartments ZIP: 10178 City: BerlinAddress* Street + Housenumber Additional information (c/o) Ville ZIP / Code postal PrivacyYou have the possibility to save your entries at any time and continue later. In this case we will store your data for up to 30 days. I have read the privacy policy and hereby agree that the personal information I have provided voluntarily may be raised, processed and used in order to provide the specified request. I agree that my confirmation of insurance will be sent to the address of my employer if I do not yet have an address in Germany. The confirmation can be sent to me and my assigned relocation company by email.Broker information*I have read the broker information according to § 15 Insurance Mediation Ordinance. I have read the broker Information.UpdatesI would like be signed up for TK-WelcomeGuide and I would like to be informed regularly by email about relevant insurance topics by Expats.de. We use the provider MailChimp to send our updates. I have read the privacy policy and hereby agree that the personal information I have provided voluntarily may be raised, processed and used in order to provide the specified request.I can unsubscribe from this update service at any time. I would like to be informed. EmployeeIs this your first time being employed in Germany?* Yes No Who is your new employer?*as written in the employment contract (exact company name)What is the address of your employer?* Adresse postale Ville ZIP / Code postal What is the first day of your work contract?* JJ . MM . AAAA Is this the same date you want to start your TK coverage?* Yes No Why is there a difference between the dates?*As a rule, the start date of the insurance should coincide with the first day of your work. A possible reason can be the start of work abroad (in home office due to Corona). Please enter the reason here.Are you a partner in and/or managing director of the company you're employed by?*In 99% of cases the answer is no, we just have to check… Yes No How many per cent of the nominal capital?*e.g. 55,5What is your monthly income (before taxes)?*Please include any bonus payments pro rata. it does not exceed 520 EUR – mini-job it is between 520 – 5.775,00 EUR it exceeeds 5.775,00 EUR StudentPlease upload your current registration letter, stating the academic semester.If you don’t have it right now we’ll follow up with you. Déposer les fichiers ici ou Sélectionnez des fichiers Taille max. des fichiers : 16 MB. What university/college are you studying at in Germany?*e.g. TU BerlinWhat is your subject area?*e.g. Mathematics – this doesn’t need to be super specificWhat is your current academic semester?*it’s 1 if you haven’t started yetVeuillez saisir un nombre entre 1 et 20.What date did you begin studying* JJ . MM . AAAA Do you study for a Masters Degree?* Yes No Have you studied in any other countries besides Germany?* Yes No How many semesters did you study abroad?If you didn’t have semesters take: years studied / 2.Do you get or have applied for benefits from the Federal Employment Agency [Agentur für Arbeit]?* Yes No German pension number / Social security numberDo you have a German pension number?*The pension insurance number has 12 characters and a letter in the ninth place. For example: 04 150872 P 08 0 Yes No What is your German pension number?*If you do not yet have a number, it will be sent to you by the TK approx. 10 days after the insurance confirmation.These next 3 questions are required instead of your pension number.What was your family name / last name at birth?*What is the place/city and country of your birth?*e.g. Madrid, SpainWhat is your nationality?*SelectAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFaroe IslandsFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNiueNorth KoreaNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabweDetails of previous insuranceWere you last insured abroad OR did you last live abroad?*in 99% all expats can answer these question with yes. If you can answer one of these question with yes -> yes. Yes No Which country?*SelectAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweWhat's your last health insurance provider?*e.g. « Name of your Insurance provider »Location (city/country)?*I am insured there since* JJ . MM . AAAA I am insured there/private until the beginning of my work/study in Germany?* Yes No I am insured there/private until* JJ . MM . AAAA If you are already in Germany before the start of the statutory health insurance, please take out a visa travel insurance for this period. You can do this here.What kind of insurance? Compulsory insurance Private insurance Depedants insurance Compulsory health/pension insuranceHave you been exempted from compulsory health insurance coverage in Germany?*Yes, if you applied for it you would have done that proactively and know about it. Yes No Please upload a copy of your confirmation of exemption from compulsory health insurance coverage.If you don’t have it right now we’ll follow up with you. Déposer les fichiers ici ou Sélectionnez des fichiers Taille max. des fichiers : 16 MB. Have you been exempted from compulsory pension insurance coverage in Germany?*In 99% of cases the answer is no, this only applies for a few really specific professions. Yes No Please upload a copy of your confirmation of exemption from compulsory pension insurance coverage.If you don’t have it right now we’ll follow up with you. Déposer les fichiers ici ou Sélectionnez des fichiers Taille max. des fichiers : 16 MB. Do you currently receive or have you applied for a state pension?*In 99% of cases the answer is no, this only applies for a few really specific professions. Yes No Do you currently receive a non-state pension and related benefits (e.g. company pension).*In 99% of cases the answer is no, this only applies for a few really specific professions. Yes No Family detailsWould you like to have your dependents covered by non-contributory dependants insurance?*e.g. children or partner who isn’t working Yes No TK will send you a letter with a one-time password. You can use this to conveniently fill out the application for family insurance online. You will receive more information in your confirmation email when you submit this application.Are you married or are you living in a civil partnership pursuant to the LPartG [German Civil Partnership Act] and your spouse/civil partner is not insured with a statutory health insurance fund?*e.g. children or partner who isn’t working Yes No Are you exempt from social long-term care insurance?* Yes No Please upload a copy of your confirmation of exemption from social long-term care insurance.If you don’t have it right now we’ll follow up with you. Déposer les fichiers ici ou Sélectionnez des fichiers Taille max. des fichiers : 16 MB. Do you have any children?*Children, who live in the same household. Your contributions to long-term care insurance are lower if you have children. Please submit the relevant proof in the next step, e.g. a copy of the birth certificate. Yes No Please upload a copy of the birth certificate here.If you don’t have it right now we’ll follow up with you. Déposer les fichiers ici ou Sélectionnez des fichiers Taille max. des fichiers : 16 MB. Contact detailsWe will pass it on to TK in case of any queries.Email* Saisissez un e-mail Confirmez l’e-mail Phone*HR contact personSignatureSignature*Voluntary informationHow did your hear about us? Search Engine (Google, etc.) Social Media (LinkedIn, Facebook, etc.) Newspaper, Blog Recommendation (virtual) Event Other Details / Link / Name …