Documenti di Didattica
Documenti di Professioni
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Personal information
male female
Title Name/Maiden name First name
My passport photograph for the new eGK I have enclosed I will submit with the picture sheet AOK already has photo
Data protection information: In order to process your insurance matters, personal data is required which the relevant AOK will save and use within the scope
of its duties ( 206, 284 SGB V). Missing, incorrect, incomplete or late information could have negative consequences ( 206 par. 2 and 307 SGB V). The
information indicated with an * is voluntary.
Consent for the AOK to use information: I consent to the relevant AOK obtaining, saving, processing and using the specified data in order to be able
to inform and advise me regarding AOK benefits and new developments, as well as optional tariffs and private supplementary auxiliary insurance from con-
tractual partners of the AOK this also applies to e-mail, telephone or SMS. I may revoke this consent at any time.
aok.de
42336
Date/signature of the customer Date/signature of the customer consultant Orga Nr.