Credit notification

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Unless we have a valid account number from you or receive instructions otherwise, entitlement to the amount in question lapses in accordance with Art. 46 of the Insurance Contract Act (ICA) after two years and you will no longer be able to claim the amount.

What type of credit balance is involved?

Please select the preferred settlement

If you prefer a payment, please specify your account details
If you wish to have the amount applied to another active policy, please specify this on the next page
If you wish to apply the amount to the same policy, you can simply cancel completion of this form. The amount will be automatically offset with the next invoice

Please note: You can attach all open ESR invoices at the end of the claims notice.

What is the policy number?

Policyholder

Contact person

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