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Student number

Personal details

Gender*

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Date of birth*

Initials

First name(s)

Last name*

Contact information

Email address*

Mobile phone

Address

Bank account

IBAN*

BIC

A BIC is only required for IBAN's not starting with 'NL'

SEPA direct debit mandate* By checking this mandate, you authorise (A) Student Association La Confrérie (Creditor ID: NL83ZZZ404086230000) to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from Student Association La Confrérie. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank.

Parents

Phonenumber

Address

Swapfiets

Interested to receive more information about Swapfiets?

Being a student isn't always easy. Thanks to Swapfiets, you now have one less thing to worry about. For a fixed monthly fee, we hand you an always-working bike. Tick the box if you would like to receive more information about Swapfiets.

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