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PSPI, Courtier d'assurances à Genève, Suisse
PSPI, Courtier d'assurances à Genève, Suisse
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  • Special risks
  • Private office
  • Corporate
  • Partnerships
  • Blog
  • Contact
  • French

Declaring a claim >> Accident LAA

  • Statement of insurance informations

  • Employer

  • Insured person

  • DD slash MM slash YYYY
  • Commitment

  • DD slash MM slash YYYY
  • business sector: reception, secretarial, IT, machine room, etc.
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • hour per week
  • hours per week
  • Date of the Accident

  • DD slash MM slash YYYY
  • :
  • Accident site

  • Accident description

  • (cycling, skiing, hiking...)
  • Persons, machines, objects, vehicles, products that played a role in the accident
  • Professional accident

  • E.g.: tool, vehicle, substance in question
  • Non-professional accident

  • DD slash MM slash YYYY
  • :
  • holidays, sickness, on leave, end of work,...
  • Injury

  • hand, foot, elbow...
  • fracture, pain, sprain...
  • Incapacity to work

  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • Doctors' addresses

  • First aid by

  • Continuation of treatment by

  • AVS (Gross) Salary

  • CHF per hourCHF per monthCHF per year
    Cost of living allowance included
  • CHF per hourCHF per monthCHF per year
  • CHF per hourCHF per monthCHF per year
  • CHF per hourCHF per monthCHF per year
  • CHF per hourCHF per monthCHF per year
  • Payment details

  • Possible comments

  • Date and place

  • DD slash MM slash YYYY
  • Attach documents

  • Drop files here or
    Accepted file types: iejpg, gif, png, pdf, Max. file size: 128 MB.
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    10 Rue du Prince, 1204 Geneva, Switzerland
    T: +41 22 317 78 50
    E: client@pspi.ch

    Trade register :
    CHE-114.803.069. FINMA : 28838

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