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

After submitting the incident note, the contact person receives an e-mail with a link for subsequent document transmission (e.g. for medical certificates).

   
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Policy

   
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Insured person

Personal data

   
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Personal details

   
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Employment data

   
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Salary data

   
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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?

   
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Accident report

Accident details

   
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Work resumption


   
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Facts

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Injury / Treatment

Main Injury

   
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Other injuries 1

   
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Other injuries 2

   
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First treated by/at physician/hospital


Treated by/at physician/hospital


   
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Comments

Comment for insurer

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Send and Print

          
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Bitte senden Sie uns die Arbeitsunfähigkeitszeugnisse im Anhang mit.
Please sens us the EO/MSE statement with in case of maternity/paternity leave.

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 or support@sunet.ch
(Mo to Fr, 8 a.m. to noon and 1 p.m. to 5 p.m.)

Version: 22500