Single payment deferral (one installment)

In case of a delay in the reminder, an additional fee of CHF 15.00 applies, along with a late interest of 5%. We are happy to grant you a payment extension.

1Please state your policy number or reference
2How high is the amount?
3When is the due amount to be paid at the latest?
4When should the deferral of payment start?
5Contact details
6Almost done

Please state your policy number or reference

Please note:
You will find this information at top right of the communication you received.

e.g. XX.XXX.XXX, XXXXXXXX, X.XXX.XXX/XXXX, XXXXXXXX/XXXX

How high is the amount?

When is the due amount to be paid at the latest?

Payment period until

Please note:
The deadline date can be found on the latest delivered document from AXA.

When should the deferral of payment start?

Desired start

The start date of the 1st instalment may be no earlier than 15 days from today and no later than 35 days after the due date of the invoice

Contact details

Title

Country

Contact person

Title

Almost done

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