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Insurance details
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Policyholder
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Health declaration
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Insured persons
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Mr R. Ramirez
Date of birth 09-12-1987
Nationality Philippine
Page 1 of 3
specialised
insurance
Desired insurance
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Details
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Premium calculation
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[]
[Creditcard]
[Deze premie is voldaan via creditcard.]
The applicant/policyholder has taken note of the exclusions, in particular the exclusion of existing
ailments and complaints, and he/she has declared to agree hereto.
Other exclusions
Costs relating to pregnancy and delivery are, among other things, also excluded. A full summary of the
exclusions may be found in the policy terms and conditions.
to have answered all questions in this health declaration completely and truthfully;
to have taken cognisance of the information with regard to the OOM Schengen Visitor Insurance
coverage on OOM Verzekeringen's website (www.oomverzekeringen.nl);
to have taken cognisance of the premium;
to have taken cognisance of the policy terms and conditions which he/she has been presented
with in step 4 of the online application, including the complaints and disputes regulations;
to have taken cognisance of the content of the "Ken uw rechten" (Know Your Rights) brochure and,
as a consequence, to have taken cognisance of the scope of the obligation to disclose, the
incidents and fraud policy, and the use of personal data;
to agree to the applicability of the policy terms and conditions that are associated with this
application and form an integral part of the policy;
to be aware that he/she must accept the issued policy and pay the premium and any insurance
tax as soon as OOM Verzekeringen has received his/her online application and decides to
accept the insurance policy. He/she is however entitled within 14 days after receipt of the policy
to cancel the insurance and return the policy to us.
Date 16-03-2018
OOM Verzekeringen
Postbox 3036 T +31 (0)70 353 21 00 E info@oomverzekeringen.nl IBAN NL91ABNA0511615140
2280 GA Rijswijk, Nederland F +31 (0)70 360 18 73 I www.oominsurance.com BIC ABNANL2A
The trade name OOM Verzekeringen is used by OOM Holding N.V. (KvK The Hague 27194193), OOM Global Care N.V. (AFM 12000623, KvK The Hague 27111654), OOM Schadeverzekering N.V. (AFM 12000624, KvK The Hague 27155593)
and "O.O.M." Onderlinge Molestverzekering-Maatschappij U.A. (KvK The Hague 27117235). These companies are registered in The Hague and share operational offices in Rijswijk.