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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Accident report

Accident details

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

   
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Accident information

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Injury

Main injury

   
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Other injury 1

   
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Other injury 2

   
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Treatment

Initial treatment by doctor/hospital


   
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Subsequent treatment by doctor/hospital


   
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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?

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Ticino +41 91 912 35 95

Do you have questions regarding the application SUNETOnline?
Sunet-Helpdesk +41 41 455 43 13
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Version: 3015