Non-contributory Dependants Co‑insurance

Tk Member Information

Reason for applying for non‑contributory dependants co‑insurance
Marital status
Previous health insurance

Spouse or Life Partner*


* pursuant to the Lebenspartnerschaftsgesetz [German Life Partnership Law] (LPartG)
We need the following details, even if you do not wish to have your spouse/life partner* co‑insured with us.
(Please enclose marriage certificate if different from member's last name.)
 Upload marriage certificate.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(If applicable)
Please give us the following details if your spouse/life partner* does not have a German Pension Insurance Number yet.
Previous health insurance of spouse/life partner*
Non-contributory dependants co-insurance of membership of:
If so, please answer the following questions for your spouse/life partner*
(Please send us a complete copy of your last income tax assessment.)
 Upload income tax assessment.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com

Kids

First Child
Second Child
(Please enclose birth certificate in case of different last names.)
 Upload birth certificate.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(If date of birth, expected format is dd/mm/yyyy)
Please give the following details if you do not have a Pension Insurance Number yet:
Period of cover
School attendance
(Please enclose certificate of school attendance for children 23 and over.)
 Upload school attendance certificate.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(Optional information)
Higher education
(Please enclose current enrolment receipt for children 23 and over.)
 Upload enrolment receipt.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(Optional information)
Basic military service or alternative community service
(Please enclose a certificate of service.)
 Upload service certificate.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(Please enclose birth certificate in case of different last names.)
 Upload birth certificate.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(If date of birth, expected format is dd/mm/yyyy)
Please give the following details if you do not have a Pension Insurance Number yet:
Period of cover
School attendance
(Please enclose certificate of school attendance for children 23 and over.)
 Upload school attendance certificate.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(Optional information)
Higher education
(Please enclose current enrolment receipt for children 23 and over.)
 Upload enrolment receipt.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(Optional information)
Basic military service or alternative community service
(Please enclose a certificate of service.)
 Upload service certificate.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com
(Relax it doesn't have to be perfect)I hereby declare that my dependants have given their consent to the processing of the required data.
(Relax it doesn't have to be perfect)Signature of spouse if applicable.
In case you are separated, you have to sign only.

We need your personal data ("social data") to correctly perform our tasks for you. Based on the Sozialgesetzbuch (SGB V) [Social Security Code book V], we have legal responsibility to comprehensively protect your personal data.