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1 Данные
2 Платёжные реквизиты
3 Медицинская декларация
4 Прочие застрахованные лица
5 Заключение договора
Заявление о страховании DKV
Сведения о страхователе и первом застрахованном лице
Oбращение
Платёжные реквизиты
Cпособ оплаты
Медицинская декларация

На все вопросы необходимо дать подробные ответы. Просьба также указать жалобы, заболевания или последствия несчастного случая, которые вы считаете незначительными.

Персональные данные застрахованного лица (застрахованных лиц)
потребление
Анкета о состоянии здоровья

Если ответ на любой из следующих вопросов будет положительным, Введите дополнительные пояснения в соответствующее текстовое поле и/или приложите подробные медицинские заключения.

1. Страдаете ли вы или страдали ли вы от какой-либо болезни, несчастного случая, расстройства, наследственного заболевания, боли в суставах и др. симптомами?
2. Проводили ли вы хирургическую, медицинскую, фармакологическую процедуру, реабилитацию или диетическое лечениеб диету (например, для пациентов с гипертонической болезнью)?
3. Находились ли вы в лечебных учреждениях или находитусь в ожидании этого?
4. было ли проведено или запланировано диагностическое обследование?
Другие застрахованные лица
Сведения о втором застрахованном лице
Oбращение
потребление

Если ответ на любой из следующих вопросов будет положительным, Введите дополнительные пояснения в соответствующее текстовое поле и/или приложите подробные медицинские заключения.

1. Страдаете ли вы или страдали ли вы от какой-либо болезни, несчастного случая, расстройства, наследственного заболевания, боли в суставах и др. симптомами?
2. Проводили ли вы хирургическую, медицинскую, фармакологическую процедуру, реабилитацию или диетическое лечениеб диету (например, для пациентов с гипертонической болезнью)?
3. Находились ли вы в лечебных учреждениях или находитусь в ожидании этого?
4. было ли проведено или запланировано диагностическое обследование?
Сведения о третьем застрахованном лице
Oбращение
потребление

Если ответ на любой из следующих вопросов будет положительным, Введите дополнительные пояснения в соответствующее текстовое поле и/или приложите подробные медицинские заключения.

1. Страдаете ли вы или страдали ли вы от какой-либо болезни, несчастного случая, расстройства, наследственного заболевания, боли в суставах и др. симптомами?
2. Проводили ли вы хирургическую, медицинскую, фармакологическую процедуру, реабилитацию или диетическое лечениеб диету (например, для пациентов с гипертонической болезнью)?
3. Находились ли вы в лечебных учреждениях или находитусь в ожидании этого?
4. было ли проведено или запланировано диагностическое обследование?
Сведения o четвёртом застрахованном лице
Oбращение