Incident note

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

Employer & Policy

Employer

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Policy information

   
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Contact person

   
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Bank account

   
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Company details

   
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Insured person

Personal data

   
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Personal details

   
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Employment data

   
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Working times

   
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Basic contractual wage

   
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Further social insurance

Does the insured person receive a daily allowance or a pension?

   
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Incapacity to work

Incapacity to work

   
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Work resumption


   
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Treatment

Initial treatment by doctor/hospital


   
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Subsequent treatment by doctor/hospital


   
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Comment

Comment for insurance

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Send and Print

          
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Submit attachment

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Support

Do you have questions related to a claim addressed to the insurance?

German switzerland +41 44 628 61 66
French switzerland +41 21 627 41 90
Ticino +41 91 912 35 95

Do you have questions regarding the application SUNETOnline?
Sunet-Helpdesk +41 41 455 43 13
(Mo-Fr: 8:00 - 12:00 and 13:00 - 17:00)

Version: 3015