Please use this form to provide us with your details in order to cancel your student insurance when you leave the Netherlands.

If you have questions about canceling your health insurance please call 088 – 121 0 221 or send an email to

    (All fields marked with * are required.)



    Family name*

    End date* (this is the day you will leave the Netherlands)

    We will ask the insurance company OOM Verzekeringen to cancel your student insurance one day after you leave. This way you are covered on the day you leave.

    Policy number*

    Email address*