Incident note

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

Employer/policy

Employer

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Contact person

   
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Payment address

   
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Policy

   
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Insured person

Personal data

   
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Foreign employee

   
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Employment data

Please capture the correct population group code (e.g. AAL10) for the insured person according to their current policy.

   
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Wages details

   
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Further information

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

   
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Incapacity to work

Incapacity to work

The percentage indicates the extent to which they are incapable of work.

PercentageStart dateFinish date
  

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Treatment

Treated by/at physician/hospital


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Comments

Comment for insurer

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Send and Print

          
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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: 3018