Form I’m going digital

Do you choose to go digital via the website? Then fill out the form below for each family member.
Through our Christmas campaign, 8 899 insureds opted to go digital in December. With this result, Vanbreda is donating € 8,899 to Cliniclowns and Bednet!
  • We recommend to use a private e-mail address.
  • Date Format: DD slash MM slash YYYY
  • You can find this on your certificate of affiliation, settlement invoice or any personal communication of us.
  • This is your bank account number that you will find on your bank card and consists of 16 to 27 characters.
  • This is a unique identification code of your bank, which you will find on your bank card.