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FULL NAME

E-MAIL

PHONE (with Country code):

ADRESS IN SPAIN (city is enough)

APPLICANT # 1

BIRTHDATE

ADD-ON ACCORDING AGE (optional)

KID CARE (0-16), ACCIDENTS (17-64), SENIOR CARE (over 65)

DON'T WANT ADD-ON

REPATRIATION (optional) 30€ per year

YES

APPLICANT # 2

BIRTHDATE

ADD-ON ACCORDING AGE (optional)

KID CARE (0-16), ACCIDENTS (17-64), SENIOR CARE (over 65)

DON'T WANT ADD-ON

REPATRIATION (optional) 30€ per year

YES

APPLICANT # 3

BIRTHDATE

ADD-ON ACCORDING AGE (optional)

KID CARE (0-16), ACCIDENTS (17-64), SENIOR CARE (over 65)

DON'T WANT ADD-ON

REPATRIATION (optional) 30€ per year

YES

APPLICANT # 4

BIRTHDATE

ADD-ON ACCORDING AGE (optional)

KID CARE (0-16), ACCIDENTS (17-64), SENIOR CARE (over 65)

DON'T WANT ADD-ON

REPATRIATION (optional) 30€ per year

YES

LEGAL ASSISTANCE, COVERS ALL THE INSURED IN THE POLICY (optional) 14€ per year

YES

COMMENTS:

DATA PROTECTION:

The data obtained from this form is only used to prepare your estimate and will then be deleted, and will not be shared with third parties.

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Also you can contact us trough whatsapp +34647492820

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CONTACTO

+34 933 45 45 16

+34 607 28 30 42

sanitas@oficinasantandreu.com

DIRECCIÓN

OC SANITAS - SANT ANDREU

C/ Gran de Sant Andreu, 230

Barcelona, 08030

HORARIO DE ATENCIÓN

Lun - Juev: 9:00 - 13:30 16:30 - 19:00
Viernes: 9:00 - 13:30
Sáb - Dom: Cerrado

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