Workplace accident or accident in private life

Would you like to make a claim on your supplementary insurance policy following a workplace accident or an accident in private life? Then send us the correctly completed accident report and the medical certificate for initial diagnosis.

Please note! You should notify us at all times of any change in your situation to stay insured properly. Please check the page Report any change in your personal or professional situation.

Accident declaration (form A1)(.pdf-New window)
Certificate of initial findings (form A2)(.pdf-New window)

You must provide us with these certificates as your case progresses, depending on your situation:

Certificate of extension of inability to work (form A3) (.pdf-New window)
Medical certificate full recovery without long-term incapacity for work (form A4)(.pdf-New window)
Medical certificate of persistence (form A5)(.pdf-New window) in the event of long-term incapacity for work
Medical death certificate (form A6)(.pdf-New window)
Accident declaration (form A8)(.pdf-New window)