Summary of the transmitted data from our online service

"Become a member - employee"

TK Membership application

employee

Information about your current insurance cover

In which country did you last have health other country

insurance cover or in which country did you
live?
Please select the country in which you had Mexico
insurance cover or lived.

Information about your employment

What is the monthly gross salary you receive more than 5.362,50 euros per month
for your employment in Germany?

Please note: Please simply add one-twelfth of your one-off payments, such as Christmas or
holiday bonuses, to your monthly gross income.

Employed since/starting on 01.09.2021

Is this your first employment as employee in yes
Germany?

Information about your employer and your position

Information about your employer

Name of employer in Germany Altiostar Networks UK Ltd

Address Lypiatt Road 1, Carrick House, GL50 2QJ
11111 Gloucestershire
Germany
My entered address is correct. checked

Membership application - employee | 13.10.2021 - 16:27:24

Are you a shareholder in this company? no

Are you self-employed? no

Personal information and start of insurance

Name Ms Dipl.-Ing. Angela Fernandes

Address Wasserburger Landstr. 8, apartment 11
81825 München
Germany
E-mail address (optional) afernand@altiostar.com

We require your e-mail address in order to confirm the receipt of your data from this application,
to name an application ID and in the event that we have additional questions regarding your
application or your membership. We will not send you advertising e-mails.

Phone number (optional) 01735432483

Date of birth 22.09.1973
Place of birth Lisbon, Portugal
Nationality Portuguese
Do you have a different maiden name? no

Do you receive a pension or have you applied no

for pension payments?

Do you receive other pension benefits (e.g. no

company pension, annuity)?

Are you exempt from health insurance and/or no

social long-term care insurance?

Do you have at least one child? yes

Would you like to take out free insurance cover no

for dependants (spouse, civil partner pursuant
to the Lebenspartnerschaftsgesetz [German
Civil Partnership Act], children)?
Your possible commencement of insurance cover with TK

Start date of insurance cover 01.09.2021

I was recruited by another TK member. checked
Name and address of TK member Alma Estefania Prado Gutierrez, Haisenheide
34

TK-WelcomeGuide

Yes, I would like to use TK-WelcomeGuide checked

E-mail address for TK-WelcomeGuide afernand@altiostar.com

Membership application - employee | 13.10.2021 - 16:27:24

Please note that you are bound to TK generally for 12 months. It is your sole responsibility to pay
your contributions. Your employer subsidises or takes on the payment of these contributions.
Further information is available here .

Submit passport photo for TK eHealth card

Would you like to upload your passport photo No, I would like to upload my passport photo
now? later.

Your application ID for download

For data privacy reasons, this document does not contain the application ID. You can download
your application ID as a separate PDF file.

Membership application - employee | 13.10.2021 - 16:27:24