Seguros Vidal
HOLDER AND FIRST INSURED PERSON
Name
NIE number
Full address
Date of birth
Profession
Nationality
You wish repatriation
No
Yes
Repatriation country
Include more insured people
No incluir más personas
1 more
2 more
3 more
SECOND INSURED PERSON
Name
NIE number
Full address
Date of birth
Profession
Nationality
You wish repatriation
No
Yes
Repatriation country
SECOND INSURED PERSON
Name
NIE number
Full address
Date of birth
Profession
Nationality
You wish repatriation
No
Yes
Repatriation country
SECOND INSURED PERSON
Name
NIE number
Full address
Date of birth
Profession
Nationality
You wish repatriation
No
Yes
Repatriation country
NEXT
Alguno de los asegurados padece o ha padecido alguna enfermedad crítica o tratamiento paliativo.
NO
YES (please specify)
Alguno de los asegurados tiene previsto o ha sido intervenido quirúrgicamente.
NO
YES (please specify)
Alguno de los asegurados ha recibido o está previsto que reciba tratamiento psiquiátrico o psicológico.
NO
YES (please specify)
Alguno de los asegurados consume o ha consumido de forma regular drogas o estupefacientes.
NO
YES (please specify)
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NEXT
Date of start
Way of payment
Yearly payments
One payment only
Interment / incineration
Interment
Incineration
You need a rental niche
YES, I don't have a niche
NO, I have one already, or I don't need it
You wish tombstone
NO
YES
Phone
Email
I have read and accept the
legal notice and data processing policy.
BACK
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