Helvetia Asistencia Familiar

Insurances > Family assistance

Name:

Sir Name:

Email:

Name:

Sir Name:

NIF:

Sex:

 Male   Female

Date of birth:

 (day/month/year)

Name:

Sir Name:

NIF:

Sex:

 Male   Female

Date of birth:

 (day/month/year)

Name:

Sir Name:

NIF:

Sex:

 Male   Female

Date of birth:

 (day/month/year)

Name:

Sir Name:

NIF:

Sex:

 Male   Female

Date of birth:

 (day/month/year)

Name:

Sir Name:

NIF:

Sex:

 Male   Female

Date of birth:

 (day/month/year)

Name:

Sir Name:

NIF:

Sex:

 Male   Female

Date of birth:

 (day/month/year)

Capital (euros):

3.000 4.000 6.000 

Cover on accidents: (Euros):

1/6.000 2/12.000 3/18.000
4/24.000 5/30.000 

Compensation for hospitalisation (euros/day):

1/6 2/12 3/18 4/24 5/30