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BVBA E. Laureys
Home
Menu
Our Team
Our vision
Insurance
Insurance
Private individuals
Self-employed & SMEs
Associations
Offer
Private individuals
Self-employed & SMEs
Calculate your price
Extra
Useful links
Digital
Available Apps
Stappenplannen
Damage
Information
Documents
Report damage
Contact
News
Language
Nederlands
English
Français
Quotation Hospitalization
Step
1
of
4
25%
Policyholder
Name
*
First
Last
Address
*
Street Address
City
ZIP / Postal Code
Email
*
Telephone
*
Date of birth
*
MM slash DD slash YYYY
Sex
M
F
X
Additional family members
Details of family members to be insured with
(Enter their name + date of birth + sex)
Additional information
Premium payment
Monthly
Quarterly
Half-yearly
Yearly
Room selection
Single room
No single room
Exemption
€0
€100
€150
€200
€250
€300
I currently already have a hospitalization insurance
No
Yes
I currently have a hospitalization insurance at work, but I wish to save to avoid sudden price increases (in case I have to continue the insurance at my name)
No
Yes
Extra
Other remarks
Name
This field is for validation purposes and should be left unchanged.
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