Salary change and salary interruption

Details of the person to be insured

Form of address *

First name *

Last name *

Date of birth *

Insured person’s AHV/AVS number  *

Please enter your AHV/AVS number (e.g. 756.1234.5678.90).

Is the insured person fully capable of working? *

Yes

Answer “no” if at least one of the following statements applies. The person to be insured: a) is considered disabled under Federal disability insurance, accident insurance or military insurance and/or is receiving benefits from at least one of these institutions; b) has been absent from work for more than three weeks prior to leaving this employer; c) is permanently restricted in their capacity to work for medical reasons.

Employment details

Company  *

Contract number  *

Reason for change *

New salary / level of employment

Start of salary interruption (e.g. unpaid leave)

End of salary interruption (e.g. return to work following unpaid leave)

Change valid as of *

Annual salary *

Level of employment *

The person to be insured is considered to be employed part-time if their regular weekly hours are shorter than those of a comparable full-time employee. The part-time employee must be fully fit for work, i.e. their capacity to work is not restricted for medical reasons.

Group of insured persons

Insured person’s plan

Insurance cover during salary interruption:

Risk cover required during interruption? *

Yes, at employee expense

For absences of more than one month, the employer may agree with the pension fund on the continuation of death and disability insurance cover (risk insurance) under this pension contract. The insured person (employee) is responsible for paying the contributions for this insurance cover.

Insured person’s address

Street and house number  *

Postcode *

Place *

Country *

Insured person’s e-mail *

Please let us know who we can contact.

Details of the contact person who entered this report and confirms the accuracy of the information.

Form of address *

First name *

Name *

E-mail *

E-mail address for any queries regarding this report.

Telephone *

Comments (e.g. availability by telephone)