Order provisional replacement certificate

If you need your European Health Insurance Card immediately, we would be happy to issue you the provisional replacement certificate.

Metadata

User Id

Form Uuid

Language

Webmail2Id

mailTo

Bcc

formType

resourceDownloadUrl

onServer

Title

Mrs./Ms.

Mr.

First name

Name

Street

N°

Postcode

Town

Date of birth

Insurance number

You will find your insurance number on the back of your health insurance card or on your insurance policy. Your insurance number has at least 10 and maximum 11 digits.

Preferred CONCORDIA agency

Please contact me by

phone

e-mail

mail

Please don't forget to enter your contact details, so that we may process your request.

Phone

E-mail

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