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--==IFJRGLKFGIR58985166UHRUHIHD
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Your message

  Subject: ICS mutatie

was not delivered to:

  info@aonstudentinsurance.com

because:

  Recipient user name info (info@aonstudentinsurance.com) not unique.  Seve=
ral matches found in Domino Directory.


--==IFJRGLKFGIR58985166UHRUHIHD
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--==IFJRGLKFGIR58985166UHRUHIHD
Content-Type: message/rfc822; name="ICS mutatie"
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From: "farinola@dominicaninstitute.org" <farinola@dominicaninstitute.org>
Reply-To: <farinola@dominicaninstitute.org>
To: <info@aonstudentinsurance.com>
Subject: ICS mutatie
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Date: Wed, 10 Apr 2019 00:12:48 +0200
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Certificaatmutatie/-opvoer individuele student
==============================================

Mutatiedatum                                 : 10-04-2019 00:12
Mutatiesoort                                 : afsluiten
Studentregistratienummer                     : 
Polisnummer                                  : FII000811167 ICS Complete
Geslacht                                     : Mr.
Voorletters                                  : Augustine
Achternaam                                   : Farinola
Geboortedatum                                : 04-08-1984
E-mail                                       : farinola@dominicaninstitute.org
Nationaliteit                                : NG-Nigeria

Soort verzekerde                             : Student/PhD student

ADRES IN NEDERLAND
==================
Adres                                        : Valkenburgseweg
Huisnummer                                   : 2
Toevoeging huisnummer                        : 
Postcode                                     : 2331AA
Woonplaats                                   : Leiden
Land van herkomst                            : NG-Nigeria
Land van bestemming                          : NL-Netherlands
Ingangsdatum                                 : 30-06-2019
Einddatum tot                                : 14-07-2019
ICS-dekking                                  : ICS Complete
(Post)bankrekeningnummer                     : 
Betalingswijze                               : Bank transfer
Betalingstermijn                             : At once
Onderwijsinstelling                          : Leiden University
Studierichting                               : Lorentz Center
Memotekst                                    : PARTICIPATION OF DH2019

BZV vragen
==========
Heeft u een betaalde baan of stage in NL?    : Nee

BEREKENDE PREMIE ICS COMPLETE
=============================
Berekende dagen                              : 14
Premie                                       : 18.32


Insurance Refusal
Has any similar insurance as requested by yourself or any interested party ever been refused or terminated or accepted/continued on special conditions?
No

Criminal record
Have you or any interested party been in contact with the police or justice as a suspect or in connection to the implementation of a punitive measure in the past 8 years?
No



Medische acceptatievragen
=========================
Do you currently have complaints, or did you have complaints about your health in the last three years? <span class="verplicht">*</span>
No

Did you consult a medical specialist in the last three years? <span class="verplicht">*</span>
No

Did you take any medication that can be obtained only on prescription from a physician or a dentist in the last three years? <span class="verplicht">*</span>
No

Are you currently pregnant? <span class="verplicht">*</span>
null

De ICS Start en ICS Start+ dekking bevatten respectievelijk geen en zeer beperkte medische dekking en dienen derhalve tezamen met een Basiszorgverzekering te worden afgesloten.

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