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Meldeformular für Unfälle oder unerwartete Erkrankung

[/vc_column_text][vc_empty_space height=”20px”][vc_column_text]Damit wir Ihnen schnell und effektiv helfen können, achten Sie bitte darauf, dieses Formular korrekt auszufüllen.[/vc_column_text][vc_empty_space height=”20px”][vc_column_text]Reichen Sie neben diesem Formular bitte zusätzlich ein:

  • eine Kopie des Arztberichtes, in dem die medizinische Diagnose aufgeführt ist
  • Kopien der bezahlten Rechnungen

Wenn Sie diese Unterlagen derzeit nicht vorliegen haben, können Sie diese auch nachreichen.[/vc_column_text][vc_empty_space height=”40px”]

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    Accident/unexpected Illness declaration form

    Please make sure to complete this form accurately to receive an effective and fast service.

    Along with the form, please also attach:

    • a copy of a medical report that details the medical diagnosis

    • copies of paid receipts

    If you do not have these documents now, you can send them at a later stage.

    Insured Member Details

    Place and time of the accident/unexpected illness

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    Type of accident/unexpected illness

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