This form will register you for Bituach Leumi coverage.

• Please fill out the form in Hebrew. If you type in English, the system will try to transliterate the text into Hebrew and will give you a chance to review and correct it.
• You may choose to import basic information from Meuhedet (optional). This can be very helpful for details like your name and address, which are sometimes difficult to transliterate accurately.
• Once completed, the form will be submitted automatically to Bituach Leumi. You should then receive a confirmation email.
• In most cases, Bituach Leumi responds with the new coverage number within one week.

If you're not sure about something or need help, feel free to contact us. We're here to make the process easier for you!

Get Started

Use this form to generate a family Bituach Leumi application.

Fill out the form below in hebrew, attatch the required documents, and follow the instruction to submit.

Husband's Information

Hebrew Last Name:

Hebrew First Name:

English Last Name:

English First Name:

Birthday:

Country of Birth: United States Canada United Kingdom

City of Birth:

Date of Marriage:

First Entry to Israel:

Last Entry to Israel:

Passport Number:

Passport Country: United States Canada United Kingdom

Passport Issue Date:

Passport Expiry:

Visa Issue:

Visa Expiry:

Father's First Name:

Father's Last Name:

Mother's First Name:

Mother's Last Name:

Phone:

SMS:

Email:

Wife's Information

Hebrew Last Name:

Hebrew First Name:

English Last Name:

English First Name:

Birthday:

Country of Birth: United States Canada United Kingdom

City of Birth:

First Entry to Israel:

Last Entry to Israel:

Passport Number:

Passport Country: United States Canada United Kingdom

Passport Issue Date:

Passport Expiry:

Visa Issue:

Visa Expiry:

Father's First Name:

Father's Last Name:

Mother's First Name:

Mother's Last Name:

Phone:

Contact Information

Street:

Knisa:

Building Number:

City:

Postal Code:iThis is a 7-digit number. If you dont know it, click here

Phone (Home):

Bank Information

Holder 1:

Holder 2:

Bank Name: אגוד אוצר החייל אל-אתיחאד ללדיכאר אלאורדון ואלכווית אלאסכאן אלאורדוני אלאסלאמי אלערבי אלבנק אלערבי אלדאולי אלפלסטיני אלעקרי אלמצרי אלערבי אלראיסי ללתנמיה בנק אלאהלי אלאורדוני בנק אלקהירה- עמאן בנק דקסיה ישראל בע"מ בנק ישראל דיסקונט הבינלאומי הראשון הדואר הפועלים וואן זירו הבנק הדיגיטלי בע"מ חסך יהב יובנק ירושלים לאומי מ.ס.ב מזרחי טפחות מסד מרכנתיל דיסקונט פאג"י פועלים שוקי הון קומרציאל ג&aspos;ורדן בנק קונטיננטל לישראל ש.ב.א Citibank HSBC Bank plc HSBC בנק מזרח תיכון SBI State Bank of India Standard Chartered

Branch Name (Snif):

Branch #:

Account #:

Uploads

Husband's Passport:

Wife's Passport:

Marriage Certificate:

Husband's Visa:

Wife's Visa:

Yeshiva Letter:

Husband's daf knisot vyitziot:

Wife's daf knisot vyitziot:

Apartment Contract:

Photo of Husband:

Photo of Wife:

Bank Letter or void check:

Submit