Beware of phishing. CM never sends you e-mails with requests to alter your personal details. How can you spot a fake e-mail?

You are not affiliated with any health insurance fund

You want to join CM in your own name (as titleholder).

You have never been affiliated with a health insurance fund, not even as a dependent? Please complete the application below and forward it. There is a separate form for international students.

We will contact you as soon as possible to arrange your registration.

Are there other family members who will join (partner, child)?
Write down their full name, Belgian national register number and status. Provide some explanation if necessary.
Main residence
Other data
I receive an income from
I am insured abroad
Insured in
If you would like to add a document to complete your registration, you can do so here.
One file only. 10 MB limit. Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.