Send your question

Should you have any questions, we will be pleased to help you.

This form contains errors. Check the fields and send again.

What is your question about? Please make your selection.

Your question

Personal details

Title

First name and surname

Are you already a customer of CZ?

yes

Do you have your CZ customer number at hand?

yes

The customer number is stated on your policy and your CZ Zorgpas.

CZ customer number

Date of birth

Day

Month

Year

Postcode

House number and possible suffix

Email address

We will send a confirmation and a copy of the filled out data to this email address

Your telephone number (not required)

We are sometimes able to help you faster if we call you

We will only use your information for the purpose of answering your question. Everything that you fill in will remain confidential.