Coracle - Application For German Blocked Account

Personal Information

I'm coming to Germany as a

First Name

Last Name

Date of Birth

Place of Birth

Country of Birth

Nationality

Second Nationality

Phone/ Mobile Number

Email

Are you tax resident in the USA?

No Yes

Are you a Politically Exposed Person?

No Yes

1

Blocked Account

Blocked Amount

Enter Your Blocked Amount

Number of Blocked Months

Sperrbetrag Blocked Amount

Summary

Blocked Amount for months:

Buffer:

Escrow Fee:

00.00 EUR

EUR

99.00 EUR

Total Amount to transfer:

EUR

Private Travel Health Insurance

I apply for Private Travel Insurance to cover the requirements for German Visa and my stay in Germany.

Expected date of arrival / Insurance Start

End of Insurance

Select your Offer

Price per Month
Treatment in hospitals including operations
Out patient treatment, drugs, medicines and bandages
Dental treatment for the relief of the pain
Medically effective and reasonable return transport from abroad
Emergency call center 24/7
Permanently disable due to accident
Accidental death
Liability cover for personal and property damage
Ergo-Coracle App
Insurance premium
Product Information pdf

Canny Cool
Good health cover

35.00 EUR
monthly

-
-
-
0.00 EUR
Select

Canny Super Cool
Good health cover +

39.00 EUR
monthly

25.000 EUR
5.000 EUR
1 Mio EUR
0.00 EUR
Coming soon

PAYMENT

Please debit the monthly premium from my account, which I will open and inform you about when I'm in Germany. Therefore I will give herewith a SEPA Mandate.

We are sorry, currently we only offer payment by direct debit

Identification

Passport Number

1

Passport

Admit Letter/Enrollment certificate

Do you stay already in Germany

No Yes

Comments

Sign here

Agreements

By ticking the box, I confirm that I read, understand, downloaded and agree to the:

Terms of Business and Data Protection of Coracle GmbH

Distance Act and Revocation Right

Depositor Information

Blocking Agreement and Information Providing Agreement

Cannywings-ERGO Terms & Condition, Insurance Product Information and SEPA Direct Debit Mandate.

Please open a blocked account based on information provided above.

Blocked Account
and
Private Travel Health Insurance

Apply your required Visa Documents within minutes!

Personal Information

Blocked Account

Private Travel Health Insurance

Select your Offer

PAYMENT

Identification

Agreements

Our Offer

QUICK LINK

Legal

Blocked Account and Private Travel Health Insurance

Apply your required Visa Documents within minutes!

Application for Blocked Account and Private Travel Health Insurance

Personal Information

Blocked Account

Private Travel Health Insurance

Select your Offer

PAYMENT

Identification

Agreements

Blocked Account
and
Private Travel Health Insurance

Application for Blocked Account and
Private Travel Health Insurance