Follow the steps to complete your application successfully.

1. Press the ‘Get Form’ button to acquire the form and open it in your preferred editor.
2. In the addressed section, fill in the institution's name: Casa de Asigurari de Sanatate Prahova, followed by the address: Ploiesti, Str.Praga, nr.1.
3. Date your application by writing the current date in the designated area.
4. Begin your request by addressing the Director General with an appropriate salutation, such as ' domnule Presedinte – Director General.'
5. Clearly state your request for the issuance of the European health insurance card as per the specified law. This should be structured and direct.
6. Include a declaration stating that you will not use the card for treatment-related travel. This declaration should affirm your understanding of potential liabilities if you misuse the card.
7. Provide your full name as both the applicant and the cardholder in the designated section following the declaration.
8. Fill in your address, ensuring to include all relevant details.
9. Enter your personal identification number (CNP), followed by your contact information including phone number and fax number.
10. Indicate your preferred contact hours in the appropriate section.
11. After completing the form, review all entered information for accuracy. Once confirmed, you may save your changes, download a copy, print it, or share the form as needed.

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