Health Insurance Application

S’aide Account ID Number*

Name*

Surname*

Place of Birth*

Date of Birth*

Father’s Name*

Mother’s Name*

Passport No*

Passport Start Date *

Passport Expiry Date *

Entry Date *

Mobile Phone *

Email*

Are you a Student ?*

Yes

University Registration Date*

Semester of Study*

Period of Study*

Faculty*

Department*

Student Number*

Degree of Study*

Other Degree of Study (if any)

Marriage Status*

Weight(kg)*

Height(cm) *

Address written on Rental Contract or Dormitory Certificate*

Passport Photo *

Biometric Photo *

Student Certificate*

Old İkamet FRONT (Optional)

Old İkamet BACK (Optional)

Please Select your Payment Method *

Bank Receipt

Cash Receipt

Online Payment

Bank Receipt*

Cash Receipt*

This field should be left blank

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E-money transactions are carried out by Birleşik Ödeme Hizmetleri ve Elektronik Para A.Ş., which is licensed by the BRSA and supervised by the CBRT within the framework of the Law on Payment and Securities Settlement Systems, Payment Services and Electronic Money Institutions No. 6493