Axa - BBTClaims + Sunet incidents

Non-occupational relapse

Incident note

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Policyholder & policy

Insured person

Personal data

Last name

First name

Address

Postal code

Location

Country of residence

E-Mail

Cell no.

Bank account

Bank account information is required for direct payments to the insured or if the employment contract has been terminated.

Insured's IBAN

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Personal details

Date of birth

SI Number

SI Number FL

Insured person has an SV number from Liechtenstein

Marital status

Gender

Nationality

Language

Underage children

Liable to withholding tax

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Accident report

Incapacity to work

Incapacity to work

Incapacity to work

Work suspension

The percentage indicates the extent to which they are incapable of work.

Percentage		Start date		Finish date

Work was resumed in full

As of when (date)

Expected duration

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Injury

Main Injury

Part of the body

Side of injury

Type of injury

Other injury

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Other injury 1

Part of the body

Side of injury

Type of injury

Other injury

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Other injury 2

Part of the body

Side of injury

Type of injury

Other injury

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Treatment

Doctor / hospital that provided initial treatment

Search term(s)

Doctor / hospital not found

Last name / first name

Title

Address

Postal code

Location

Country of residence

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Subsequent treatment by doctor/hospital

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Doctor / hospital not found

Last name

Title

Address

Postal code

Location

Country of residence

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Operator help

Do you have technical questions about BBTClaims?

Sunet Helpdesk +41 41 455 30 30
(Mo-Fr, 8am to 12pm and 1pm to 5pm)

Do you have any questions about the insurance or policy?

+41 800 809 810

Version: 22500

Incident note

Policyholder & policy

Policyholder

Contact person

Company details

Insured person

Personal data

Bank account

Personal details

Employment data

Working time

Basic contractual wage

Further social insurance

Accident report

Accident details

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

Accident information

Incapacity to work

Incapacity to work

Injury

Main Injury

Other injury 1

Other injury 2

Treatment

Doctor / hospital that provided initial treatment

Subsequent treatment by doctor/hospital

Send and Print

Submit attachment

Submit attachment

Operator help

BBTClaims | Data privacy & Cookie reference

Incident note

Policyholder & policy

Policyholder

Contact person

Company details

Insured person

Personal data

Bank account

Personal details

Employment data

Working time

Basic contractual wage

Further social insurance

Accident report

Accident details

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

Accident information

Incapacity to work

Incapacity to work

Injury

Main Injury

Other injury 1

Other injury 2

Treatment

Doctor / hospital that provided initial treatment

Subsequent treatment by doctor/hospital

Send and Print

Submit attachment

Submit attachment

Operator help