Incident note

Fill in the following fields with your data in order to complete the incident note.

Employer & Policy

Employer

Data in processing...

Policy information

   
Data in processing...

Contact person

   
Data in processing...

Company details

   
Data in processing...

Insured person

Personal data

   
Data in processing...

Personal details

   
Data in processing...

Employment data

   
Data in processing...

Working time

   
Data in processing...

Accident report

Accident details

   
Data in processing...

Accident information

Characters remaining:

   
Data in processing...

Injury

Main Injury

   
Data in processing...

Other injury 1

   
Data in processing...

Other injury 2

   
Data in processing...

Treatment

Initial treatment by doctor/hospital


   
Data in processing...

Subsequent treatment by doctor/hospital


   
Data in processing...

Send and Print

I confirm the correctness of the data.
          
Data in processing...

Submit attachment

Submit attachment

The document transmission is available only after successful sending of the incident.

Operator help

Do you have any questions about the insurance or policy?

Call 0800 822 022

Do you have any questions about the software?

Sunet-Helpdesk: 041 455 43 09

(Mo-Fr, 8:00 - 12:00 and 13:00 - 17:00)

Version: 2020