Apply for Au pair insurance

With the application form below you can apply for the ISIS Au Pair Insurance.

The applicant has received explicit permission from all parties involved to use and share the entered data with JoHo Insurances and the other parties involved. In the context of the duty of care and the interest of the au pair, both the host family and the au pair agency will be informed about this application.

1. Who applies for this insurance?

Applicant insurance
Consent host family

2. Details au pair agency

Name au pair agency
Enter the name of the organization when not listed
Indicate here through which official referent (au pair agency) arranged the mediation.

3. Details policyholder (host family)

The policyholder is the 'owner' of the insurance. The policyholder is responsible for paying the premium, and only a policyholder may communicate changes and requests for termination.

All documents of this Isis Au pair insurance will be sent to the host family by email. These documents always come with an English-language instruction, which the host family can hand over to the au pair.

Gender

4. Details au pair

Gender

5. Travelling details au pair and coverage ISIS au pair insurance

The start date of the insurance must be the day of departure of the au pair from her/his own country.
Has the au pair already left the home country?
Additional questions if the au pair has already left the home country
Is the au pair coming over from another host family in the Netherlands (rematch)?

Additional policy conditions

  • In principle, it is not possible to take out au pair insurance if the au pair is already in the Netherlands. The ISIS au pair insurance makes it possible to take out insurance under certain conditions.
  • The most important additional conditions when applying when the au pair is already in the Netherlands:
    • The insurance takes effect immediately
    • Existing conditions/complaints are excluded from coverage, even if this arose while the au pair was already in the Netherlands, but prior to the start date of the insurance. Any follow-up costs will not be reimbursed.
Did your au pair already have an au pair insurance through the other host family?

6. Desired coverage ISIS au pair insurance

Coverage
Does your au pair already have a basic health insurance?
Would you like the All-in or Additional cover for the Au pair Insurance?
Only one file. 10 MB max. Allowed file types: jpg, jpeg, pdf.

7. SEPA mandate for a single collection

The premium for the insured period, entered above, will be paid in one single collection.

Creditor information
JoHo
Stationsweg 2D
2312 AV Leiden, the Netherlands
Creditor ID: NL25ZZZ280766440000

8. Closing questions

Have you or another interested party been in contact with the police or the judiciary in the past 8 years?
Has an insurer ever refused or canceled an insurance policy for you or another interested party?
Have you or another interested party suffered or caused more than 3 damages in the past 5 years as a result of events that fall under the insurance that you have applied for?

9. Agree with the conditions and send by email

Acceptance text, Privacy statement, Closing text & Other notices

TERMS & CONDITIONS

  • The data provided and data yet to be provided may be included in the client database maintained by De Goudse. A privacy policy applies to this.
  • The applicant (policyholder) declares to accept the application of the general terms and conditions, which are available for inspection at the organization.
  • The applicant (policyholder) declares to have answered the questions correctly and completely, to have seen and agree to the terms, insurance card, and privacy statement, and to pay the due premium and costs.

ACCEPTANCE

  • Your application is accepted the moment you receive the policy document. The insurance commences on the effective date you have indicated.
  • By applying for this insurance, you declare that the questions have been answered to the best of your knowledge, correctly and truthfully, and that you thereby wish to obtain the requested insurance. The duty to provide information includes everything that may be of importance for assessing the risk to be insured and the person of the applicant and/or insured. You are nevertheless required to fully answer questions the answers to which you assume are already known to De Goudse / ISIS (the insurer).
  • You must still disclose facts and circumstances that were requested and that become known to you after this application has been sent, but before De Goudse / ISIS has made a final decision regarding the application. If, in addition to yourself, there are one or more other insured persons covered by this insurance who are at least 16 years old, you must also report to JoHo the facts and circumstances that are known to, or ought to be known to, this person or persons. If, after the conclusion of the agreement, it appears that one or more questions have been answered incorrectly or incompletely, this may lead to the right to benefits being limited or even forfeited. If you have acted with the intention of misleading De Goudse / ISIS, or if De Goudse / ISIS would not have concluded the insurance policy with knowledge of the true state of affairs, the insurer also has the right to terminate the insurance.
  • With this application, you declare that you accept the application of the policy conditions. These are available for inspection at the JoHo support centers and can be viewed on the JoHo website or are included with the issuance of the policy.

OTHER NOTICES

  • JoHo is not responsible for printing errors, inaccuracies, and interim changes regarding the information on the website. No rights can be derived from this information; for the exact coverage, we refer to the policy conditions.
  • JoHo is an official insurance intermediary.
Privacy Statement & Processing of Personal Data:
  • Personal data is requested when applying for insurance and other financial services. This data is processed by De Goudse for the purpose of entering into and executing agreements, for carrying out marketing activities, for the prevention and combating of fraud against financial institutions, for statistical analysis, and to comply with legal obligations. The Code of Conduct for the Processing of Personal Data by Financial Institutions applies to the processing of personal data. A consumer brochure regarding this Code of Conduct can be requested from De Goudse. You can consult the full text of the Code of Conduct on the website of the Dutch Association of Insurers, www.verzekeraars.nl. You can also request the Code of Conduct from the Dutch Association of Insurers (P.O. Box 93450, 2509 AL The Hague, telephone 070-3338500).
CIS Foundation

When applying for, modifying, or handling an insurance policy or claim, De Goudse may consult and register your data and, if relevant, data of other parties involved in the database of the CIS Foundation (Central Information System). The CIS Foundation is a joint database of insurers in the Netherlands.

What do De Goudse and other insurers use the CIS database for?

  • De Goudse uses this database for a careful underwriting and claims handling policy, to manage risks and prevent fraud. Other insurers affiliated with the CIS Foundation may use this data for the same purposes.

When does De Goudse record data?

  • If you file a claim, this is recorded in the CIS database. This recording takes place as soon as you, or someone else, reports a claim for which insurance coverage has been requested. This also applies if no payout ultimately takes place or if you decide to pay for the damage yourself.
  • The registration takes place regardless of who is liable for the damage, or whether it falls within your policy conditions or remains under your deductible.

How does De Goudse handle your privacy?

  • The privacy regulations of Stichting CIS apply to the use of the CIS database. The registration and consultation of data takes place in accordance with the applicable rules of Stichting CIS.
  • You can find more information at www.stichtingcis.nl.

Your rights

  • You have the right to know which personal data about you is being processed. You can submit a request for this via Stichting CIS.
Fraud
  • Fraud is defined as (attempting to) obtain, under false pretenses, a (periodic) benefit, entitlement, or insurance coverage to which there is no actual entitlement.
  • Fraud (in whole or in part) results in no (periodic) benefit or entitlement being granted at all, nor in any insurance coverage being provided. Furthermore, fraud may result in:
    • a report being filed with the police or the Public Prosecution Service;
    • the insurance policy(ies) being terminated;
    • registration taking place in the signaling system used between insurers;
    • recovery takes place of any benefit(s) already paid and the monetary value – of wrongly granted claims, or insurance coverage will be denied;
    • recovery takes place of any costs already incurred to establish a claim or the right to a (periodic) benefit.
Applicable law and complaints
  • Dutch law applies to the insurance. You can submit complaints regarding the execution of the insurance agreement to the Complaints Committee De Goudse, P.O. Box 9, 2800 MA Gouda. If the decision of the Complaints Committee is not satisfactory, you can turn to the Foundation for Financial Services Complaints Institute (KiFiD), P.O. Box 93257, 2509 AG The Hague, telephone 0900-3552248. For more information, you can also visit www.kifid.nl.
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