Declarations

If you need Groupama Private Health Insurance, please fill out the 3 types of Declaration forms (with computer, we do not accept handwritten documents) as follows:

• After printing, enter the date and your signature (by hand with a blue pen)

• On the first form, cross the box on page 2

Declaration: you can download the official forms HERE:

1. Declaration You must bring in 2 copies of the declaration form!

2. Declaration of Approval

3. Declaration ERIX

Please bring all the completed and signed declarations (3 types) to the ÉSZI SH office (R building ground floor room 10) during business hours (Monday, Wednesday, Friday: 9-13).

Please read these documents carefully.

Complaints Handling Policy

Customer Information

INSTRUCTIONS FOR COMPLETING

Fill in this section with a computer!

- Neptun code: 6 letters and numbers

- Insurance policy number: don't write anything here