StudentCover quotation

APolicyHolder

As the policyholder to the Plan, you are the legal representative towards Golden Care of all persons to insure included on this application form. The policyholder may choose not to be insured if cover is required for dependant(s) only.

Name of the school*

BCoverage

Choose your deductible plan (in CHF)

Choose your type of room:

StudentCover A (shared room in hospital) StudentCover B (private room)

DPremium

Please select the frequency of your premium :*

Yearly Half-yearly (every 6 months) Quarterly (every 3 months) Monthly (every month)

Email address*

Spouse

Gender*

Area of
coverage*

StudentCover quotation

APolicyHolder

Name of the school*

Title*

Civil Status*

Gender*

Mobile phone*

BCoverage

DPremium

Please select the frequency of your premium :*

Spouse

Gender*

Area of coverage*

StudentCover quotation

APolicyHolder

Name of the school*

Title*

Civil Status*

Gender*

Mobile phone*

BCoverage

DPremium

Please select the frequency of your premium :*

Area of
coverage*