Formular Unfalldeckung einschliessen

Insurance no.

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First name

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Last name

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Address

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Postcode

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City

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Mail

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Phone (daytime)

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Date of birth

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Include accident coverage on

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Please note: for statutory reasons, we can also include accident cover retroactively and invoice it with the premium at a later date.

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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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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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