チェコ留学・ワーホリ保険

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Subsction form

Please fill out the form below.

Surname

First name

sex

男性

女性

Date of birth

Nationality

Zip code

Czech address or Residence address

Phone number

Starting date

Name of emergency contact

Relation with emergency contact

Address of emergency contact

Email of emergency contact

Telephone of emergency contact

SS の登録が未済

SSの仮登録が済

SSの本登録が済

required documents　*

You have to upload 3 required documents.
And up to your Sécurité sociale registration status, you have to also upload the certificate of Sécurité Sociale.
Note: PDF files and password-protected documents cannot be uploaded.

Un justificatif d’identité / Passport with photo page

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Un visa étudiant / Student VISA

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Admission letter or Certificate of registration(Acceptation d’inscription de l’université ou Attestation d’inscription pour l’année universitaire en cours)

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◆ Please upload the following document if you have already registered for Sécurité Sociale provisionally or full registration.

Provisional certificate of affiliation to health insurance or Social Security certificate or Carte Vitale(Attestation provisoire d’affiliation à l’assurances maladie ou Attestation de Sécurité sociale ou copie de Carte Vitale)

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Medical insurance for international students in France

チェコ留学・ワーホリ保険

your

brand

Subsction form

required documents　*

You have to upload 3 required documents.
And up to your Sécurité sociale registration status, you have to also upload the certificate of Sécurité Sociale.
Note: PDF files and password-protected documents cannot be uploaded.

◆ Please upload the following document if you have already registered for Sécurité Sociale provisionally or full registration.

Mentions légales et politique de confidentialité

チェコ留学・ワーホリ保険

your

brand

Subsction form

required documents *

You have to upload 3 required documents. And up to your Sécurité sociale registration status, you have to also upload the certificate of Sécurité Sociale. Note: PDF files and password-protected documents cannot be uploaded.

◆ Please upload the following document if you have already registered for Sécurité Sociale provisionally or full registration.

required documents　*

You have to upload 3 required documents.
And up to your Sécurité sociale registration status, you have to also upload the certificate of Sécurité Sociale.
Note: PDF files and password-protected documents cannot be uploaded.