This form will register your child 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 helpful for details like your child’s 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 child’s 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.

Child's Information

Hebrew Last Name:

Hebrew First Name:

English Last Name:

English First Name:

Birthday:

Gender: Male Female

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:

Mobile (Primary):

Secondary Phone:

SMS:

Email:

Parent's Information

Father's First Name:

Father's Last Name:

Father BTL Number:

Mother's First Name:

Mother's Last Name:

Mother BTL Number:

Contact Information

Street:

Knisa:

Building Number:

City:

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

Uploads

Child's Passport:

Child's Visa:

Child's daf knisot vyitziot:

Photo of Child:

Submit