Form to obtain an individual account statement for insured persons residing outside Switzerland

To obtain an individual account statement free of charge, please complete the form below.

Supporting documents to be attached:

• a valid identity document of the insured person (double-sided identity card or passport)
  
• the power of attorney below and the identity document of the representative if the request concerns a third party

Power of attorney (PDF, 47 kB, 15.03.2017)

Fields marked with an asterisk (*) are mandatory.

Error in order form

Civility title

*

Madam

Madam

Sir

Sir

OASI Number

 

Nationality/ies

*

Please state all nationalities

Surname/s

*

Previous surname/s

 

First name/s

*

Date of birth

*

dd.mm.yyyy

Marital status

*

Spouse’s name

 

Street, number

*

Postal code

*

Town/City

*

Country

*

Telephone

 

E-mail

*

I wish to receive the statement of account by

*

Post

Post

Secure e-mail via IncaMail only for non-EU/EFTA residents

Secure e-mail via IncaMail only for non-EU/EFTA residents

See below "receipt of account statement"

State an official language for our reply

*

French

French

German

German

Italian

Italian

Download insured person’s identity document

*

If you are a representative please download the following documents :

Power of attorney

 

Download representative's identity document

 

Please note that the maximum processing time is 60 days (by e-mail and by post).

---

Receipt of account statement

• by post

You will receive it within 60 days of receipt by our Services. Should this not be the case, please fill in our contact form.

• by secure e-mail via IncaMail

Step 1: Within 60 days, you receive an e-mail from us with the mention « Secured by IncaMail » on the subject line

Step 2: Open the message and click on the « Read » button

Step 3: You receive another e-mail from us with a security code. Click on the "Read message now" button and enter the code.

Step 4: Download the account statement attached to the e-mail.

Last modification 27.02.2024