Apply for Au pair insurance

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

Important documents

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

Au pair agency

Host family

Consent host family

The au pair agency has explicit permission from the host family to submit this application on behalf of the 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.

E-mail address au pair agency

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.

Sir

Madam

First name

Last name

Date of birth

E-mail address

Telephone number

Street and house number

Postal code

City

Country

4. Details au pair

Sir

Madam

First name

Last name

Date of birth

Country of origin

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?

Yes

Departure date au pair from home country

Is the au pair coming over from another host family in the Netherlands (rematch)?

Yes

From what date will the au pair be in your home?

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.

Yes, I agree to the additional policy conditions

Did your au pair already have an au pair insurance through the other host family?

Yes

I don't know

Which insurance was this and do you have a policy number?

6. Desired coverage ISIS au pair insurance

Coverage

Standard

Super

Does your au pair already have a basic health insurance?

Yes

I don't know

Would you like the All-in or Additional cover for the Au pair Insurance?

All-in

Additional

Policy schedule of the Dutch health insurance

Only one file. 10 MB max. Allowed file types: jpg, jpeg, pdf.

Number of months

7. SEPA mandate for a single collection

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

Yes, I authorize JoHo to debit the premium owed once from my bank account

Yes, I authorize JoHo to debit the premium owed once from the bank account of the host family and I have permission for this from the host family

Exact name as mentioned on your bank account

IBAN bank account

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?

Yes

Has an insurer ever refused or canceled an insurance policy for you or another interested party?

Yes

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?

Yes

Give your explanation here if you had to answer 'yes' to 1 or more questions

9. Agree with the conditions and send by email

Yes, I agree to the policy conditions

Yes, I agree to receive digitally (via email) information, policy documents and payment reminders

I would like to receive the information belonging to this insurance by email in the following language

Dutch

English

Date

JoHo Foundation

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aupairverzekeringen.nl is part of JoHo, a non-profit organization that aims to empower people and organizations to develop and work better together, thereby contributing to a tolerant and sustainable world

Contact

Address: Stationsweg 2-D, 2312 AV Leiden
Online & Phone: Contact page

About JoHo:

JoHo.org: Concept & Purpose