Student Membership Application Form

Personal information


If no German pension insurance number has been assigned, we will require the following information:

Your health insurance cover details


I was last
Important: Please  Upload a copy of your exemption letter.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com

Details on income


I am employed or self‑employed during my studies.

Details on your studies


Important: Please  Upload your current registration letter.
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com

Details on pension payments
(Leave blank if unsure)


Details on dependants
(In case you are accompanied by your spouse / children)


Details on long-term care insurance


Important: Please  Upload proof (e.g. copy of the birth certificate).
(Max filesize: 1 MB, Accepted Formats: pdf, jpg, png)
or
later, send to: publicinsurance@pegaone.com

For queries


Please sign (legal representative, if applicable) below:
(Relax it doesn't have to be perfect)