You are affiliated with CM as a dependent

Do you want to join in your own name (as a beneficiary), for example because you are starting to work as a self-employed?

Are you a CM member, registered as a dependent? To join as a beneficiary, for example, because you're starting work as a self-employed person, please complete the application below. We will contact you as soon as possible to arrange your registration as a beneficiary.

Do you want to join because you're starting work as an employee or because you're unemployed? Then don't use the form below, but register using the form for employees/unemployed.

Identification

First name

Last name

Marital status

Nationality

National register number

Main residence

Street

House number

Bus

Country

Postal code

City or municipality

Telephone/mobile phone

Email address

Change of status

Reason for change of status

I have been working as a self-employed person since:

Other…

Since (date)

Other data

Interested in additional CM insurance?

Get insured for when you are admitted to hospital.

Insure yourself for medical expenses without hospitalization.