AUFNAHMEANTRAG

    Applicant

    Gender
    FemaleMale

    Surname, First name (*)

    Street address (*)

    PLZ (*)

    City

    Telephone number (*)

    Email (*)

    Data and family members

    Is one of the people living in the household terminally chronically ill or currently undergoing medical treatment?
    JaNein

    Surname, First name (*)

    Relationship

    Date of birth

    Birthplace

    Nationality

    If yes, type of illness

    Applicant

    Spouse

    SonDaughter

    SonDaughter

    SonDaughter

    Children under 18 years are accepted without a certificate, from 19 - 27 years only with a school certificate or certificate of study.

    Admission fee

    Age

    18 -- 29

    0,00 Euro

    One-time enrollment fee:

    Plus 119.95 euros per year

    Age

    30 -- 49

    49,95 Euro

    Age

    50 -- 54

    399,95 Euro

    Age

    55 -- 59

    899,95 Euro

    Wartefrist 180 Tage (6 Monate) nach Beginn der Mitgliedschaft.

    Desired payment method

    TransferSEPA direct debit mandate

    I/We authorise you to collect payments from my/our account by direct debit. At the same time, I/we instruct my/our bank to honour the direct debits drawn on my/our account by Pikellimi GmbH. Note: I/We can demand reimbursement of the debited amount within eight weeks of the debit date. The conditions agreed with my/our bank shall apply.

    Bankdaten

    Name der Bank:

    IBAN:

    Kontoinhaber falls abweichend:

    I have read and agree to the general terms and conditions of Pikellimi GmbH. Terms and ConditionsLINK

    DATEN UND FAMILIENANGEHÖRIGE

    Is one of the people living in the household terminally chronically ill or currently undergoing medical treatment?
    Children under 18 years are accepted without a certificate, from 19 - 27 years only with a school certificate or certificate of study.

    AUFNAHMEGEBÜHR

    One-time enrollment fee:
    Plus 119.95 euros per year
    Wartefrist 180 Tage (6 Monate) nach Beginn der Mitgliedschaft.

    GEWÜNSCHTE ZAHLUNGSART

    I/We authorise you to collect payments from my/our account by direct debit. At the same time, I/we instruct my/our bank to honour the direct debits drawn on my/our account by Pikellimi GmbH. Note: I/We can demand reimbursement of the debited amount within eight weeks of the debit date. The conditions agreed with my/our bank shall apply.
    I have read and agree to the general terms and conditions of Pikellimi GmbH.
    en_GB

    Füllen Sie das Formular entsprechend Ihren Anforderungen aus oder kontaktieren Sie unsere Vertreter.

    ABOUT US

    Pikellimi GmbH is a German company based in Gelnhausen, Hesse, founded in 2013 and part of the Pikellimi Transport Group, established by one of the largest Albanian private investors. The group has been operating across Europe since 1999 and has earned an excellent reputation for high-quality and reliable services. Our specialty is financial security through covering transport costs and funeral planning.

    Contact