Individual Seafarer Insurance | Instant Quote Calculator

✦ HEALTH INSURANCE

INDIVIDUAL CREW SUBSCRIPTION

PREMIUM CALCULATOR

Configure your coverage and get an instant quote

1. Your Age

Select your age range:

2. Family Members

Would you like to add family members?

Yes

Husband/Spouse:

Spouse age range:

Child(ren):

Privilege Plan: The price includes spouse and unlimited children. The calculation is based on the average age of the parents.

3. Subscription Duration

Select coverage duration:

Note: Plans Perfect and Privilege are only available for subscriptions of 6 months or more.

4. Health Plan

Essential – Basic coverage –

Standard – Enhanced coverage –

Perfect – Comprehensive coverage –

Privilege – Premium coverage –

5. Coverage Area

Area 1: Worldwide

Area 2: Worldwide limited to emergency treatment for USA, Canada, United Kingdom, Jersey, Guernsey, Switzerland, Israel, Bahamas, Japan, Singapore, Hong Kong, Australia, Russia. Outside the area, the coverage is limited to emergency treatments for a maximum duration of 90 consecutive days.

Area 3: Worldwide limited to emergency treatment for USA, Canada, United Kingdom, Jersey, Guernsey, Switzerland, Israel, Bahamas, Japan, Singapore, Hong Kong, Australia, Russia, United Arab Emirates. Outside the area, the coverage is limited to emergency treatments for a maximum duration of 90 consecutive days.

Area 4: ASEAN limited to emergency treatment for Singapore, Hong-Kong, Japan and AFRICA limited to emergency treatment for South Africa and The Seychelles. Outside the area, the coverage is limited to emergency treatments for a maximum duration of 90 consecutive days.

Select your coverage area:

6. Currency

Select your preferred currency:

6. Additional Options

Death & Permanent Disability

Accident Only –

Any Causes –

None

Temporary Total Disability –

Legal Expenses Protection –

7. Payment Method

Select payment frequency:

Your Quote Summary

⚠️ Important: Prices are indicative and subject to medical questionnaire approval.

ℹ️ How to use: Select your age, duration, and health plan to get started.

Individual crew insurance calculator

Configure your coverage and get an instant quote

1. Your Age

Select your age range:

2. Family Members

Would you like to add family members?

Yes

Husband/Spouse:

Spouse age range:

Child(ren):

Privilege Plan: The price includes spouse and unlimited children. The calculation is based on the average age of the parents.

3. Subscription Duration

Select coverage duration:

Note: Plans Perfect and Privilege are only available for subscriptions of 6 months or more.

4. Health Plan

Essential - Basic coverage -

Standard - Enhanced coverage -

Perfect - Comprehensive coverage -

Privilege - Premium coverage -

5. Coverage Area

Area 1: Worldwide

Select your coverage area:

6. Currency

Select your preferred currency:

6. Additional Options

Death & Permanent Disability

Accident Only -

Any Causes -

None

Temporary Total Disability -

Legal Expenses Protection -

7. Payment Method

Select payment frequency:

Your Quote Summary

⚠️ Important: Prices are indicative and subject to medical questionnaire approval.

ℹ️ How to use: Select your age, duration, and health plan to get started.

General Conditions

HEALTHCARE PLAN (OPTION 1-2)

TEMPORAL TOTAL DISABILITY (OPTION 3)

LEGAL PROTECTION (OPTION 4)

Subcription form

"*" indicates required fields

1PARTICIPANT DETAILS

2PLAN OPTIONS

3PAYMENT AND DURATION OPTION

4MEDICAL QUESTIONNAIRE & VALIDATION

This field is hidden when viewing the form

langue

Gender*

Mrs

Participant Name*

Last Name First Name

Date of Birth*

DD slash MM slash YYYY

Marital status

Familly plan

YES

Do you wish to add a spouse and/or child(ren) to your plan?

Spouse/Husband

Date of Birth*

DD slash MM slash YYYY

Spouse/Husband date of birth

Child(ren)

under 18 years old

COUNTRY*

Function/Occupation*

Telephone*

Email*

enter your email confirm your email

Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Currency for the Plan*

EUR

USD

All limits will be based on the currency chosen

OPTION 1

HEALTHCARE PLAN*

ESSENTIAL

STANDARD

PERFECT

PRIVILEGE

Coverage Zone*

Zone 1 : Worldwide

Zone 2 : Worldwide limited to emergency treatment for USA, Canada, United Kingdom, Jersey, Guernsey, Switzerland, Israel, Bahamas, Japan, Singapore, Hong Kong, Australia, Russia Outside the area, the coverage is limited to emergency treatments for a maximum duration of 90 consecutives days

Zone 3 : Worldwide limited to emergency treatment for USA, Canada, United Kingdom, Jersey, Guernsey, Switzerland, Israel, Bahamas, Japan, Singapore, Hong Kong, Australia, Russia, United Arab Emirates Outside the area, the coverage is limited to emergency treatments for a maximum duration of 90 consecutives days

Zone 4 : ASEAN limited to emergency treatment for Singapor, Hong-Kong, Japan and AFRICA limited to emergency treatment for South Africa and The Seychelles Outside the area, the coverage is limited to emergency treatments for a maximum duration of 90 consecutives days

Choose your area of coverage.

OPTION 2 A

DEATH AND PERMANENT DISABILITY (Accident Only)

100 000

300 000

500 000

200 000

400 000

none

OPTION 2 B

DEATH AND PERMANENT DISABILITY (Any Causes)

100 000

300 000

500 000

200 000

400 000

none

DEATH AND PERMANENT DISABILITY (Any Causes)

100 000

300 000

500 000

200 000

400 000

none

You cannot subscribe option 2A and option 2B. Please check “none” in 2B if you want only option 2A.

BENEFICIARY DESIGNATION (in event of death)

Spouse or in absence of, Born children or to be born, on equal parts

Others

Indicate here : Name, date of birth, address and pourcentage for each beneficiary in case of death

OPTION 3

TEMPORAL TOTAL DISABILITY (Any Causes)

none

2 000

4 000

6 000

3 000

5 000

8 000

7 000

Amount (Premium/year). Cover : maximum 80% on salary. Waiting Period 28 days
Work Contract required

TEMPORAL TOTAL DISABILITY (Any Causes)

2 000

4 000

6 000

3 000

5 000

8 000

7 000

none

Amount (Premium/year). Cover : maximum 80% on salary. Waiting Period 28 days
Work Contract required

OPTION 4

LEGAL EXPENSES

Formula Seafarer

none

SUBSCRIPTION DETAILS

Effective Date of Coverage*

DD slash MM slash YYYY

For individual enrolment, the insurance contract start the first of each month to the due date 31/12.

Periodicity (months)*

3 months minimum. You are able to cancel the policy at any time by email. Any month started shall be due in full. 12 months= 1 year with automatic renewal

FREQUENCY OF PAYMENT*

Monthly (+6%)

Half Yearly (+2%)

Yearly

(fees)

FREQUENCY OF PAYMENT*

Half Yearly (+2%)

Yearly

(fees)

PAYMENT METHOD*

Credit Transfer

Direct Debit (Sepa Area EUR only)

Bank check (EUR only)

Height (cm or Ft)*

Weight (kg)*

Usual Blood Pressure at Rest*

1. Are you currently on sick leave?*

Yes

2. Have you been on sick leave for more than 10 days in the last 3 years?*

Yes

3. Have you been hospitalised (in a hospital, clinic, spa, etc.) in the last 10 years for one or more: – surgical interventions – medical monitoring/treatment*

Yes

4. Have you had any illnesses or accidents in the last 10 years that required medical supervision (treatment, medical care, regular medical monitoring, etc.) for more than 15 days?*

Yes

5. Are you currently under medical supervision (treatment, medical care, regular medical check-ups, etc.) and/or taking medication prescribed by a doctor (other than contraceptives)?*

Yes

6. Were you covered at 100% by a governmental social security system for medical reasons as part of a Long-term condition before the application for insurance coverage? If so, please specify the condition.*

Yes

7. In the next 12 months, will you have to endure: – a medical or surgical operation? – a medical examination (radiology, laboratory examination, MRI, scanner, consultation, etc.)? – medical treatment of any kind (psychology, physiotherapy, radiotherapy, speech therapy, chemotherapy, dental treatment, medication, etc.)?*

Yes

8. Have you had any abnormal biological and/or serological tests in the last 5 years?*

Yes

9. Did any of your parents, brothers or sisters (including deceased ones) suffer, before the age of 65, from diabetes, heart problems, high blood pressure, high cholesterol, cancer, kidney problems, polyposis of the colon, or any other hereditary pathology?*

Yes

10. Do you consume: – more than 10 cigarettes a day? – more than 2 glasses of wine (or equivalent) a day?*

Yes

11. Do you use or have you ever used drugs (marijuana, hashish, etc.)? If you have stopped, since when?*

Yes

12. Have you ever undergone psychotherapy or consulted a psychiatrist? If so, when?*

Yes

If you answered “Yes” to any of these questions, please provide details below, including dates, duration, specific medical grounds or reasons, any ongoing effects, treatments received, and test results. If you answered “Yes” to more than one question, please indicate the corresponding question number for each response.*

Declaration

I hereby declare that:

I have received and read the information booklet relating to the health insurance contract underwritten by WCA.
I have provided all the information requested in a complete, honest, and accurate manner. I acknowledge that this questionnaire must be completed by each person to be insured and that all questions must be answered.
I am aware that, in accordance with Article L.113-8 of the Insurance Code, and independently of the ordinary causes of nullity and subject to the provisions of Article L.132-26 of the Insurance Code, the cover granted to the Member by the Insurer shall be null and void in the event of concealment or intentional misrepresentation by the Member, whether at the time of subscription or during the term of the contract, when such concealment or misrepresentation alters the nature of the risk or reduces the Insurer’s assessment thereof, even if the omitted or misrepresented risk has had no influence on the occurrence of the claim.
I am aware that, in the event of a claim or any request for assistance, the deliberate and voluntary submission of inaccurate or fraudulent documents will result in the forfeiture of cover, without reimbursement of any contributions already paid.
I reside and work outside the borders of the country of which I am a national.
I undertake to report any change relating to my family members within fifteen (15) days of becoming aware of such change.

I declare that the answers provided, whether written by me or on my behalf, are true and complete to the best of my knowledge and belief and shall form the basis of the certificate of insurance issued under my application for the Plans.

I understand that failure to disclose any material fact may invalidate the certificate of insurance.
A material fact is any information that may influence the assessment or acceptance of your application for the Plans. If you are in any doubt as to the relevance of any information, please provide full details. Failure to disclose a material fact may result in the loss of your benefits.

If I do not designate a successor, I declare that any benefits shall be payable to the WCA Social Fund. I confirm that I have freely chosen to designate Association WCA asbl as the sole beneficiary and that I am fully aware of its statutes and social activities.

I agree to inform FROLSON or Worldwide Crew Association a.s.b.l. (hereinafter referred to as “the Company”) in writing of any change in my circumstances occurring between the date of this application and the issuance of the certificate of insurance. I also agree to notify the Company of any change of name, address, or other personal details that may occur during the term of the Plan. I consent to the Company seeking independent verification, if deemed necessary, of any information provided in this application.

Annual taxes & WCA fees: 50 (€ / $ / £)

Any dispute arising under the Plans shall be subject exclusively to the jurisdiction of the courts of Luxembourg.

I acknowledge that I have read and unconditionally accept the General Conditions applicable to each option selected.

I agree to the Terms of Service

Conditions générales*

Déclaration

Je déclare par la présente que :

J’ai reçu et pris connaissance de la notice d’information relative au contrat d’assurance santé souscrit par WCA.
J’ai fourni toutes les informations demandées de manière complète, sincère et exacte. Je reconnais que ce questionnaire doit être complété par chaque personne à assurer et que toutes les questions doivent recevoir une réponse.
Je suis informé(e) que, conformément à l’article L.113-8 du Code des assurances, indépendamment des causes ordinaires de nullité et sous réserve des dispositions de l’article L.132-26 du Code des assurances, la garantie accordée au Membre par l’Assureur est nulle et non avenue en cas de réticence ou de fausse déclaration intentionnelle du Membre, tant lors de la souscription qu’en cours de contrat, lorsque cette réticence ou fausse déclaration modifie l’objet du risque ou en diminue l’appréciation par l’Assureur, même si le risque omis ou dénaturé n’a pas eu d’influence sur la réalisation du sinistre.
Je suis informé(e) qu’en cas de sinistre ou de demande d’assistance, la production consciente et volontaire de documents inexacts ou frauduleux entraînera la déchéance des garanties sans remboursement des cotisations déjà versées.
Je réside et travaille en dehors des frontières du pays dont je possède la nationalité.
Je m’engage à déclarer tout changement concernant les membres de ma famille dans un délai de quinze (15) jours à compter de la date à laquelle j’en ai eu connaissance.

Je déclare que les réponses fournies, qu’elles soient rédigées de ma main ou non, sont exactes et complètes à ma connaissance et constitueront la base du certificat d’assurance délivré dans le cadre de ma demande d’adhésion aux Plans.

Je comprends que toute omission ou déclaration inexacte d’un fait matériel peut entraîner la nullité du certificat d’assurance.
Un fait matériel est toute information susceptible d’influencer l’appréciation ou l’acceptation de votre demande d’adhésion aux Plans. En cas de doute sur la pertinence d’une information, veuillez en fournir le détail. Le défaut de déclaration d’un fait matériel peut entraîner la perte de vos garanties.

À défaut de désignation d’un successeur, je déclare que les prestations seront versées au Fonds social de WCA. Je confirme avoir librement choisi de désigner l’Association WCA asbl comme bénéficiaire unique et être pleinement informé(e) de ses statuts et de ses actions sociales.

Je m’engage à informer par écrit FROLSON ou Worldwide Crew Association a.s.b.l. (ci-après « la Société ») de tout changement de situation intervenant entre la date de la présente demande et l’émission du certificat d’assurance. Je m’engage également à informer la Société de tout changement de nom, d’adresse ou de toute autre donnée personnelle survenant pendant la durée du Plan. J’autorise la Société à procéder, si nécessaire, à toute vérification indépendante des informations fournies dans la présente demande.

Taxes annuelles & frais WCA : 50 (€ / $ / £)

Tout litige relatif aux Plans sera soumis exclusivement à la compétence des tribunaux luxembourgeois.

Je reconnais avoir pris connaissance et accepter sans réserve les Conditions générales applicables à chaque option choisie.

J’accepte les Conditions générales

Condizioni generali*

Dichiarazione

Dichiaro quanto segue:

Di aver ricevuto e letto il fascicolo informativo relativo al contratto di assicurazione sanitaria sottoscritto da WCA.
Di aver fornito tutte le informazioni richieste in modo completo, veritiero e accurato. Riconosco che il presente questionario deve essere compilato da ogni persona da assicurare e che tutte le domande sono obbligatorie.
Di essere a conoscenza che, ai sensi dell’Articolo L.113-8 del Codice delle Assicurazioni, indipendentemente dalle cause ordinarie di nullità e fatte salve le disposizioni dell’Articolo L.132-26 del Codice delle Assicurazioni, la copertura concessa al Membro dall’Assicuratore è nulla in caso di reticenza o dichiarazione dolosa del Membro, sia al momento della sottoscrizione sia nel corso del contratto, qualora tale reticenza o dichiarazione alteri la natura del rischio o ne riduca la valutazione da parte dell’Assicuratore, anche se il rischio omesso o dichiarato erroneamente non ha influito sul verificarsi del sinistro.
Di essere a conoscenza che, in caso di sinistro o richiesta di assistenza, la presentazione consapevole e volontaria di documenti inesatti o fraudolenti comporterà la perdita della copertura senza rimborso dei contributi già versati.
Di risiedere e lavorare al di fuori del paese di cui possiedo la cittadinanza.
Di impegnarmi a comunicare qualsiasi modifica relativa ai miei familiari entro quindici (15) giorni dal momento in cui ne vengo a conoscenza.

Dichiaro che le risposte fornite, sia scritte di mio pugno che da terzi, sono vere e complete secondo la mia conoscenza e costituiranno la base del certificato di assicurazione emesso a seguito della mia domanda di adesione ai Piani.

Comprendo che l’omessa dichiarazione di un fatto rilevante può invalidare il certificato di assicurazione.
Un fatto rilevante è qualsiasi informazione che possa influenzare la valutazione o l’accettazione della domanda di adesione ai Piani. In caso di dubbio sulla rilevanza di un’informazione, si prega di fornirne i dettagli. L’omessa dichiarazione di un fatto rilevante può comportare la perdita dei benefici.

In assenza di designazione di un successore, dichiaro che le prestazioni saranno versate al Fondo Sociale WCA. Confermo di aver liberamente scelto di designare l’Associazione WCA asbl come unico beneficiario e di essere pienamente a conoscenza dei suoi statuti e delle sue attività sociali.

Accetto di informare per iscritto FROLSON o Worldwide Crew Association a.s.b.l. (di seguito “la Società”) di qualsiasi cambiamento della mia situazione intervenuto tra la data della presente domanda e l’emissione del certificato di assicurazione. Accetto inoltre di informare la Società di qualsiasi cambio di nome, indirizzo o altri dati personali durante la durata del Piano. Autorizzo la Società a effettuare, se ritenuto necessario, verifiche indipendenti delle informazioni fornite nella presente domanda.

Tasse annuali e contributi WCA: 50 (€ / $ / £)

Qualsiasi controversia relativa ai Piani sarà di esclusiva competenza dei tribunali del Lussemburgo.

Riconosco di aver letto e di accettare senza riserve le Condizioni Generali applicabili a ciascuna opzione selezionata.

Accetto le Condizioni Generali

Condiciones generales*

Declaración

Declaro por la presente que:

He recibido y leído el folleto informativo relativo al contrato de seguro de salud suscrito por WCA.
He proporcionado toda la información solicitada de manera completa, veraz y exacta. Reconozco que este cuestionario debe ser completado por cada persona a asegurar y que todas las preguntas son obligatorias.
Soy consciente de que, de conformidad con el Artículo L.113-8 del Código de Seguros, independientemente de las causas ordinarias de nulidad y sujeto a lo dispuesto en el Artículo L.132-26 del Código de Seguros, la cobertura concedida al Miembro por el Asegurador será nula en caso de ocultación o declaración falsa intencionada por parte del Miembro, ya sea en el momento de la suscripción o durante la vigencia del contrato, cuando dicha ocultación o declaración altere la naturaleza del riesgo o reduzca la valoración del mismo por parte del Asegurador, incluso si el riesgo omitido o tergiversado no ha influido en la ocurrencia del siniestro.
Soy consciente de que, en caso de siniestro o solicitud de asistencia, la presentación consciente y voluntaria de documentos inexactos o fraudulentos dará lugar a la pérdida de la cobertura sin reembolso de las contribuciones ya abonadas.
Resido y trabajo fuera de las fronteras del país del cual soy nacional.
Me comprometo a informar cualquier cambio relativo a mis familiares dentro de un plazo de quince (15) días desde que tenga conocimiento del mismo.

Declaro que las respuestas proporcionadas, ya sean escritas por mí o en mi nombre, son verdaderas y completas según mi leal saber y entender, y constituirán la base del certificado de seguro emitido en relación con mi solicitud de adhesión a los Planes.

Entiendo que la falta de declaración de un hecho relevante puede invalidar el certificado de seguro.
Un hecho relevante es cualquier información que pueda influir en la evaluación o aceptación de su solicitud de adhesión a los Planes. En caso de duda sobre la relevancia de alguna información, por favor proporcione los detalles. La falta de declaración de un hecho relevante puede dar lugar a la pérdida de sus prestaciones.

En ausencia de designación de un sucesor, declaro que las prestaciones serán abonadas al Fondo Social de WCA. Confirmo haber elegido libremente designar a la Asociación WCA asbl como beneficiario único y ser plenamente consciente de sus estatutos y actividades sociales.

Acepto informar por escrito a FROLSON o Worldwide Crew Association a.s.b.l. (en adelante, “la Compañía”) de cualquier cambio en mis circunstancias ocurrido entre la fecha de esta solicitud y la emisión del certificado de seguro. Asimismo, acepto informar a la Compañía de cualquier cambio de nombre, dirección u otros datos personales que se produzcan durante la vigencia del Plan. Autorizo a la Compañía a solicitar, si se considera necesario, una verificación independiente de la información proporcionada en esta solicitud.

Impuestos anuales y tasas WCA: 50 (€ / $ / £)

Cualquier controversia derivada de los Planes será sometida exclusivamente a la jurisdicción de los tribunales de Luxemburgo.

Reconozco haber leído y aceptar sin reservas las Condiciones Generales aplicables a cada opción seleccionada.

Acepto las Condiciones Generales

Allgemeine Geschäftsbedingungen (AGB)*

Erklärung

Hiermit erkläre ich:

Dass ich das Informationsheft zum von WCA abgeschlossenen Krankenversicherungsvertrag erhalten und gelesen habe.
Dass ich alle angeforderten Informationen vollständig, wahrheitsgemäß und korrekt angegeben habe. Ich erkenne an, dass dieser Fragebogen von jeder zu versichernden Person auszufüllen ist und dass alle Fragen verpflichtend zu beantworten sind.
Dass mir bewusst ist, dass gemäß Artikel L.113-8 des Versicherungsgesetzbuches, unabhängig von den gewöhnlichen Nichtigkeitsgründen und vorbehaltlich der Bestimmungen des Artikels L.132-26 des Versicherungsgesetzbuches, der dem Mitglied vom Versicherer gewährte Versicherungsschutz im Falle einer vorsätzlichen Verschweigung oder Falschangabe durch das Mitglied sowohl bei Vertragsabschluss als auch während der Laufzeit des Vertrages nichtig ist, sofern diese Verschweigung oder Falschangabe den Gegenstand des Risikos verändert oder die Einschätzung des Risikos durch den Versicherer mindert, selbst wenn das verschwiegene oder falsch angegebene Risiko keinen Einfluss auf den Eintritt des Versicherungsfalls hatte.
Dass mir bewusst ist, dass im Falle eines Schadens oder eines Antrags auf Unterstützung die bewusste und freiwillige Vorlage unrichtiger oder betrügerischer Unterlagen zum Verlust des Versicherungsschutzes ohne Rückerstattung bereits gezahlter Beiträge führt.
Dass ich außerhalb der Grenzen des Landes lebe und arbeite, dessen Staatsangehörigkeit ich besitze.
Dass ich mich verpflichte, jede Änderung in Bezug auf meine Familienangehörigen innerhalb von fünfzehn (15) Tagen nach Kenntniserlangung mitzuteilen.

Ich erkläre, dass die gemachten Angaben, unabhängig davon, ob sie von mir selbst oder in meinem Namen gemacht wurden, nach bestem Wissen und Gewissen vollständig und wahrheitsgemäß sind und die Grundlage für die Ausstellung der Versicherungsbescheinigung im Rahmen meines Antrags auf die Pläne bilden.

Ich verstehe, dass die Nichtangabe eines wesentlichen Umstands zur Ungültigkeit der Versicherungsbescheinigung führen kann.
Ein wesentlicher Umstand ist jede Information, die die Bewertung oder Annahme Ihres Antrags auf die Pläne beeinflussen kann. Im Zweifelsfall geben Sie bitte alle relevanten Details an. Die Nichtangabe eines wesentlichen Umstands kann zum Verlust Ihrer Leistungen führen.

Sofern kein Nachfolger benannt wird, erkläre ich, dass die Leistungen an den WCA-Sozialfonds ausgezahlt werden. Ich bestätige, dass ich mich freiwillig dafür entschieden habe, die Association WCA asbl als alleinigen Begünstigten zu benennen, und dass mir deren Satzung und soziale Tätigkeiten vollständig bekannt sind.

Ich verpflichte mich, FROLSON oder die Worldwide Crew Association a.s.b.l. (nachfolgend „das Unternehmen“) schriftlich über jede Änderung meiner persönlichen Umstände zwischen dem Datum dieses Antrags und der Ausstellung der Versicherungsbescheinigung zu informieren. Ich verpflichte mich ferner, das Unternehmen über jede Namens-, Adress- oder sonstige Änderung während der Laufzeit des Plans zu informieren. Ich erkläre mich damit einverstanden, dass das Unternehmen bei Bedarf eine unabhängige Überprüfung der in diesem Antrag gemachten Angaben vornimmt.

Jährliche Steuern und WCA-Gebühren: 50 (€ / $ / £)

Alle Streitigkeiten im Zusammenhang mit den Plänen unterliegen ausschließlich der Zuständigkeit der Gerichte in Luxemburg.

Ich bestätige, dass ich die Allgemeinen Bedingungen gelesen habe und diesen vorbehaltlos zustimme.

Ich akzeptiere die Allgemeinen Geschäftsbedingungen

Condições gerais*

Declaração

Declaro, para os devidos efeitos, que:

Recebi e li o folheto informativo relativo ao contrato de seguro de saúde subscrito pela WCA.
Forneci todas as informações solicitadas de forma completa, verdadeira e exata. Reconheço que este questionário deve ser preenchido por cada pessoa a segurar e que todas as perguntas são obrigatórias.
Tenho conhecimento de que, nos termos do Artigo L.113-8 do Código de Seguros, independentemente das causas ordinárias de nulidade e nos termos do Artigo L.132-26 do Código de Seguros, a cobertura concedida ao Membro pela Seguradora será nula em caso de omissão ou declaração falsa intencional por parte do Membro, quer no momento da subscrição quer durante a vigência do contrato, quando tal omissão ou declaração altere a natureza do risco ou reduza a sua apreciação pela Seguradora, ainda que o risco omitido ou declarado incorretamente não tenha influenciado a ocorrência do sinistro.
Tenho conhecimento de que, em caso de sinistro ou pedido de assistência, a apresentação consciente e voluntária de documentos inexatos ou fraudulentos implicará a perda da cobertura, sem reembolso das contribuições já pagas.
Resido e trabalho fora do país da minha nacionalidade.
Comprometo-me a comunicar qualquer alteração relativa aos meus familiares no prazo de quinze (15) dias a contar da data em que tome conhecimento da mesma.

Declaro que as respostas fornecidas, quer sejam da minha autoria ou prestadas em meu nome, são verdadeiras e completas segundo o meu melhor conhecimento e servirão de base para a emissão do certificado de seguro no âmbito da minha candidatura aos Planos.

Compreendo que a omissão de um facto relevante pode invalidar o certificado de seguro.
Um facto relevante é qualquer informação suscetível de influenciar a avaliação ou aceitação da sua candidatura aos Planos. Em caso de dúvida quanto à relevância de qualquer informação, forneça os respetivos detalhes. A omissão de um facto relevante pode resultar na perda dos seus benefícios.

Na ausência de designação de um sucessor, declaro que os benefícios serão pagos ao Fundo Social da WCA. Confirmo que escolhi livremente designar a Associação WCA asbl como beneficiário único e que estou plenamente consciente dos seus estatutos e das suas atividades sociais.

Comprometo-me a informar por escrito a FROLSON ou a Worldwide Crew Association a.s.b.l. (doravante designada “a Empresa”) de qualquer alteração da minha situação ocorrida entre a data da presente candidatura e a emissão do certificado de seguro. Comprometo-me igualmente a informar a Empresa de qualquer alteração de nome, endereço ou outros dados pessoais durante a vigência do Plano. Autorizo a Empresa a proceder, se considerado necessário, à verificação independente das informações fornecidas na presente candidatura.

Impostos anuais e taxas WCA: 50 (€ / $ / £)

Qualquer litígio decorrente dos Planos será da exclusiva competência dos tribunais do Luxemburgo.

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