Incident note

Fill in the following fields with your data in order to complete the incident note.

Employer/policy

Employer

Data in processing...

Contact person

   
Data in processing...

Policy

   
Data in processing...

Insured person

Personal data

   
Data in processing...

Personal details

   
Data in processing...

Employment data

   
Data in processing...

Salary data

   
Data in processing...

Further information

Is the insured person already receiving a pension or a daily allowance?

Other social security benefits

Is the insured person already entitled to a daily allowance or pension from a health insurance, Swiss Accident Insurance Fund (Suva) or another compulsory accident insurance, disability insurance, old-age and survivors' insurance, occupational pension plan, military insurance, unemployment insurance or maternity indemnity?

   
Data in processing...

Accident report

Accident details

   
Data in processing...

Until when did the insuree work in the company before the accident occured?

   
Data in processing...

Facts

Characters remaining:

   
Data in processing...

Incapacity to work



   
Data in processing...

Work resumption


   
Data in processing...

Injury / Treatment

Main Injury

   
Data in processing...

First treated by/at physician/hospital


Treated by/at physician/hospital


   
Data in processing...

Send and Print

          
Data in processing...

Submit attachment

Submit attachment

The document transmission is available only after successful sending of the incident.

User assistance

Do you have any questions regarding insurance your insurance or policy?

Please contact 0844 80 81 88

Do you have any technical questions or problems?

Sunet-Helpdesk: +41 41 455 43 06
(Mo to Fr, 8 a.m. to noon and 1 p.m. to 5 p.m.)

Version: 3019