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In case you are in need of the Additional Groupama Health Insurance, please fill out (with computer, we do not accept handwritten documents) the Declaration as it follows:

  • After printing enter the date and your signature (by hand with a blue pen)
  • Cross the box on page 2
  • You must bring in 2 copies of the declaration form!

Declaration: you can download the official forms LINK


Instructions for completing

1. Fill in this section with a computer!

- Neptun code: 6 letters and numbers

- Insurance policy number: don't write anything here

2. Make an x with a pen

3. Date: The day you bring in the declaration. Write with a computer or with a blue pen

4. Signiture: Sign by hand with a blue pen

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