Care College オンライン申し込みの記入方法
Care College

online application

Health insurance for language pupils & students
Notes on completing the form

After having filled out the online form, you will receive a printable insurance certificate by e­mail, if all information are complete and valid. You
can generally already use this to apply for or extend the visa or residence permit. After successful assessment of your application we will also
send you an original copy of the insurance policy, pre­printed medical treatment certificates and an insurance card by mail within two workingdays.
Help: auxiliary information you will find touching theImportant questions

next to the respective fields.

今までCare Concept社の保険に加入したことはありますか？

Has the insured person already been insured with ourselves?

今までドイツで健康保険に加入したことがありますか？

Did the IP hold health insurance in the travel country before commencement of coverage?

Policyholder / Contracting Party

保険名義人は法人ですか？（個人の場合はNoにチェック）Is the insured party a company?
Salutation

First nameMr.

男性はMr.

NamaeMyouji

No

Yes

No

Yes

No

生年月日Date of birth

Last name

下の名前

Yes

名字2310日

Are the policyholder and the insured person identical?

月Age

1995

21年

Yes

保険の名義人と保険対象者は同一ですか？（同一であれば Yes）

女性は Ms.を選択

Policyholder’s address/Contact information

c/o〜様方（空欄可）

Street no 番地

Postal code City郵便番号

Region* | Country 空欄

If the policyholder’s name is not on the letter box, please enter
the displayed name in the field c/o.

市区町村

Japan

国を選択

Insured person

Salutation

First nameMr.

Last nameNamae

23Myouji10

1995

21NationalityJapan

契約開始日（入国日）

Insurance plan

Inception dateCare College Comfort

2504

2017

希望プランを選択日月年

Information about stay abroad

滞在する国

Residence before starting tripJapanAge

国籍を選択

Information about health insurance | Show premium table

プランの確認はここをクリック

Date of birthCountry of stay
Germany

Duration
12 Months

契約期間を選択

入国日

Entry/departure date25

04

2017

Select as the country of stay the country in which you will be residing during the term of the insurance cover.

日

渡航前に住んでいる(た)国月

年

Reason for stay abroad
Working Holiday

滞在の理由を選択

Information about liability­ and accident insurance

Do you want to take out liability and/or accident insurance?

賠償責任保険・事故保険プランに加入する場合は Yes、しない場合は No.

YesNo（Yesを選択した場合のみ以下のプラン選択欄が表示されます。）
Information about liability­ and accident insurance

希望プランを選択
Insurance plan
Type M

契約開始日（入国日）
Inception date2504

2017

契約期間を選択
Duration

12 MonthsPremium*€ 48,00

one­off* The premium will be shown after choosing the payment method.
The premium for the liability insurance respectively liability and accident insurance can only be paid monthly if you selected monthly and Direct
debit as the method of payment and chose at least 6 months as term of insurance.
Liability insurance protects you against claims for damages from a third party.
Accident insurance protects against financial hardships incurred through the reduction of your ability to work either because of a disability ordeath following an accident.
In addition to health insurance we offer – in a legally separate policy – personal liability insurance or a personal
liability/accident insurance package with the following scope:
Liability insurance
Lump sum coverage for personal injury and property damage

Type SType M

EUR 1 Mio.

EUR 2 Mio. EUR 2.5 Mio.

Type XL

Deportation costs to cover undertakings of the policyholder versus German authorities

EUR 1,000

EUR 2,000EUR 3,000Co­insurance of damage to rented property for immovable objects, deductible 10%, minimum EUR 250.00 perclaim

EUR 10,000

EUR 25,000

EUR 50,000­­EUR 1,000

EUR 250

EUR 0

EUR 0Loss­of­key cover for private dwellings (resp. room or apartment), deductible EUR 100.00 per claim
General deductible per claim

Type SType MType XLBasic invalidity amount

Accident insurance­

EUR 30,000

EUR 40,000

Maximum invalidity sum with progressive scale 350%

­ EUR 105,000 EUR 140,000

Death benefit in the event of accidental death­

EUR 15,000

EUR 25,000

Salvage costs following an accident­

EUR 7,500

EUR 10,000

Cosmetic operations due to an accident­

EUR 2,500

EUR 5,000

Monthly premium*EUR 2

EUR 4

EUR 7.50

Minimum premium

EUR 10

EUR 12

EUR 15* The premium must be paid as a single premium for the entire term. Insurance cover only exists, if the insurance premium is paid completely.

For a complete list of benefits see the Conditions of liability/accident insurance.

Please choose how you want to pay the insurance premium

Direct debit monthly■ 支払い方法を選択

毎月引き落とし（要ドイツ口座）

Direct debit one­off

Bank transfer monthly 毎月振込み一括引き落とし（要ドイツ口座）

Bank transfer one­off 一括振込
one­off

一括カード払いone­off

一括PayPal払い

If paying by bank transfer or paying in cash, you should always make sure that the money will be received on time and that you indicate yourpolicy number as well as the period to which the payment relates.
In case of payment­interval one­off the premium will be collected for the entire period of coverage at the beginning of the agreed coverage
period.
Premium calculation

ここに支払い方法による保険料が表示されます€ 420,00 one­off

Health insurance€ 48,00

Liability insurance
Accident and liability insurance

one­off

The health insurance premium increases as of the month 18 up to € 59.00 monthly（１８ヶ月後以降は保険料は異なります）

Additional information for contact in the event of questionse­mailArea code*

Telephone*

Fax­no.*Where did you hear about us?

メールアドレス

空欄

空欄

空欄

Pers. recommendation

Here you can fill in a further e­mail­address, to which we will send the insurance documents aditionally.*

上記メールアドレス以外のアドレスでもメールを受け取る場合にここにメールアドレスを記入
The fields marked with an * asterisc are not compulsory for conclusion of the policy, but it makes easier to approach you. You won’t get
unrequested advertising by e­mail.

Agency / broker number

エージェント番号記入欄

エージェント番号を入力して申し込んだ場合に日本語でサポート致します。
この項目が表示されていない場合も問題なくサポート致します。

Agency number or broker number at the Care Concept AG =>Conditions health insurance

003142000G

こちらの番号を入力

By clicking on the adjoining field you are confirming that you have read, understand and agreed the following conditions. At the same time
you are confirming that you have printed and / or downloaded the following conditions:Terms and conditions

ここをチェックConditions health insurance
Information on the [German] Long Distance Sales Act (Fernabsatzgesetz)
Explicit statements
Product information sheet
Consumer information

Conditions of liability/accident insurance

By clicking on the adjoining field you are confirming that you have read, understand and agreed the following conditions. At the same time
you are confirming that you have printed and / or downloaded the following conditions:
Conditions of liability/accident insurance

ここをチェック

Product information sheet
Consumer information

Send application

By sending the form you are entering into a binding agreement to conclude an insurance policy via Care Concept® AG in Bonn with HanseMerkur
Reiseversicherung AG . On beginning studies at a German college or university, you are normally covered by the statutory health insurance. Aftersending you will receive a confirmation of receipt of your application and a few minutes later an e­mail with your documentation. We will send you
your written documents by mail within two working days. In the event of further questions Care Concept is only to be pleased to be of service inseveral languages on the free number from the fixed­line telephone network in Germany 0800 977 35 00 otherwise dial +49 228 97735­11.

Send application

ここをクリックして、入力確認画面へ※ 次の入力確認画面で、内容を確認して 申し込みボタンをクリック

保証内容は以下のページでご確認頂けます。
http://dj-ﬁnanz.de/care-college/

ご質問、お問い合わせは以下までどうぞ
info@dj-ﬁnanz.de

Line ID: shigeyamakata

山片重嘉
Shigeyoshi Yamakata
DJ-Finanz

Kurstr. 16, 61231 Bad Nauheim, Germanyt. +49 6032 9982 8500
m. +49 173 3166 547

www.facebook.com/DJ.Finanz
www.dj-ﬁnanz.de