Auto entrepreneur business registration - Declaration Social/Assurance Maladie

CEA
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I am registering my business online as an auto-entrepreneur, filling out the form Déclaration de début d’activité. In the section DECLARATION SOCIALE it asks:

PERSONNES DEMANDANT A BENEFICIER DE VOTRE ASSURANCE MALADIE DE LA SECURITE SOCIALE - INDEPENDANTS

What do I fill in in the boxes below? My own information? Leave the boxes blank? I am single, never married, with no children, so I have no dependents.

Please advise. Thank you.

Eric

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