Formular Unfalldeckung ausschliessen

Insurance no.

This field must be filled out

First name

This field must be filled out

Last Name

This field must be filled out

Address

This field must be filled out

Postcode

This field must be filled out

City

This field must be filled out

Mail

This field must be filled out

Phone (daytime)

This field must be filled out

Date of birth

This field must be filled out

Accident exclusion

This field must be filled out

We will exclude accident insurance for you as of the first day of the month following the date this form was sent.

This field must be filled out

Comments

This field must be filled out

I would like to exclude the accident insurance from my basic insurance (BASIS)*

I understand that if I withdraw from the accident insurance of my employer, I have to notify ÖKK about this within a month. ÖKK can demand the premium difference for the accident cover if I fail to notify them.

This field must be filled out

HIN encryption

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

This field must be filled out

* 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.

This field must be filled out