Online conclusion in 2 steps:

1. Carefully complete the application form.

2. On page two double-check your indications and confirm the application.

You will immediately receive your cover note. Shortly after, we will send an e-mail confirmation to the address indicated by you.

Details about the applicant:
Address 
Title 
First name 
Family name 
Company 
Street and house number 
Postal code 
City 
Country 
Email 
Telephone 
Data of the person to be insured:
Address 
First name 
Family name 
Date of birth  . .  
Home country 
Duration of cover:
Date of arrival  . .  
Start of insurance  . .  
End of insurance  . .  
The insurance should be taken out before leaving the home country. However, it can also be taken out ten days after entry.
Premium and scope of coverage:
 Persons
up to 64 years
Persons aged
65 years or older
Minimum premium: 20,00 €
Method of payment:
In the following methods of payment the total sum will be debited.
After insurance conclusion you will be redirected to SIX Payment Services (Europe) S.A.
 
Six/Saferpay 
 
Alternatively you can pay by using the SEPA direct debit scheme.
 
Payment by SEPA direct debit 
I hereby authorize DR-WALTER GmbH to collect payments from my / our account by direct debit mandate. I further instruct my bank to pay the direct debits drawn on my / our account by DR-WALTER GmbH.
Payment 
The total amount will be debited in the form of a single payment from the given account.
Account holder 
IBAN 
BIC 
Name and domicile of financial institution 
 
DR-WALTER GmbH, Eisenerzstr. 34, 53819 Neunkirchen-Seelscheid, Germany / Creditor Identifier: DE76ZZZ00000887121 / Mandate Reference: your insurance policy number
Space for special notes:
 
Do you require advice?
If you have any questions, please feel free to contact us:

Phone: +49 (0) 2247 9194 -982

Telegram Messenger

Mon-Fri: 8 am to 6 pm