健保申請資料填寫表單 Health Insurance Application Form

*姓名 Name:

*出生年月日 Date of Birth:

*手機號碼 Phone Number:

*申請原因 Reason:

首次加保 First time insurance
已有健保要轉入本校 Transfer existing insurance to our school
遺失 Lost
毀損 Damaged

*居留證號碼 ARC Number:

*居留證正反面掃描檔 Scan of front and back of ARC:

*大頭照 2-inch Color Photo:

清寒證明文件檔 (僑生如有請提供):

*驗證碼