Formular Name ändern

First name

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Last name

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Insurance no.

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Date of birth

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Name change

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New first name

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New last name

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Reason for name change

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Add an official document (max. file size 10MB)*

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Mail

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Change valid as of

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Have your bank/post office account details also changed in connection with your change of name? If so, please indicate your new IBAN and account holder name here.

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IBAN-no.

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Account holder

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Comments

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HIN encryption

I would like to receive any documents via HIN-encrypted message.

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* Required field

The information provided will not be passed on to third parties. These data will only be stored and used to process the relevant matter.

By submitting the form, you confirm that you have acknowledged and accepted the Data protection notice.

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