Get Affidavit For Health Insurance Coverage - Eap Ucop

Filling out the affidavit for health insurance coverage is a crucial step for individuals planning to reside in Italy. This guide provides step-by-step instructions to ensure users can confidently complete the form online.

Follow the steps to successfully complete the affidavit form.

1. Press the ‘Get Form’ button to access the affidavit, allowing you to open it in your preferred online editor.
2. Begin by entering your first name, middle name (if applicable), and last name in the designated fields at the top of the form.
3. Fill in your date of birth in the format (day-month-year) in the specified section.
4. Provide the place of birth by entering the town and state where you were born in the designated area.
5. Enter your permanent residence address in the appropriate field, ensuring all parts of the address are accurate.
6. Input your phone number, starting with the area code, into the designated telephone number section.
7. Carefully read the sworn statements section, ensuring you understand the declaration about reporting to the Italian Questura for the issuance of your residence permit.
8. Choose one of the health insurance options, either by marking the box for the policy with I.N.A. ASSITALIA or the alternative private health insurance policy.
9. Confirm that your insurance coverage will be in effect for the entirety of your stay in Italy without limitations or deductions.
10. Date the document and include the location where it is being completed.
11. Sign the affidavit in the ‘Signature of the student’ section, ensuring your signature matches the name provided earlier.
12. Lastly, leave space for the notary public to complete the notarization section, which includes signature and official seal once it is submitted.

Complete your affidavit online today to ensure your health insurance coverage is arranged for your stay in Italy!