Amsterdam UMCAbout Amsterdam UMC Registration form for new patients (international students) UHP - registration form for international students 1 van 6 Volgende Personal data Volgende Your situation Volgende Drug use Volgende Your (medical) history Volgende Signature Volgende Completion project.general_error_message Salutation Mr. Mrs. I don't identify as either a man or a woman Your initials Your given name Your surname Street name and house number Zip code Place name Your mobile telephone number Your e-mail address Your date of birth Place of birth Your Dutch social security number ("BSN") Leave blank when unknown or not available The name of the health insurance company Insurance number Upload a proof of your insurance Do you have: Dutch health insurance? Make a picture of the backside of the insurance card. AON? Make a picture of the insurance certificate stating the expiry date of the certificate. EHIC? Make a picture of the backside of the insurance card. Upload a scan or photo of your health insurance card. Make sure that the insurance number and your name are clearly visible. Versleep bestand naar hier of Selecteer bestand Verwijder bestand Name of person to be notified in case of emergency Telephone number of the person to be notified in case of emergency Living situation Don't want to share (yet) Single Married Divorced Living together Widow(er) Roommate Next step
