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.

Civility title

*

Madam

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

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

German

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

The account statement will be sent to you within 3 months of receipt of the request by our Services.

Please do not contact us during this period to avoid slowing down the process.

by secure e-mail via IncaMail

Step 1: Within 3 months, you will receive an e-mail from us with "Secured by IncaMail" in the subject line.

Please do not contact us during this period to avoid slowing down the process.

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.