Details of the employer

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Details of the employee


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Details of re-entry

At the time of returning to work, is the insured fully capable of working or earning? A person is considered to have a partial incapacity for work if, at the commencement of the insurance term, he/she has to be fully or partially absent from work for health reasons, is receiving daily sickness benefits as a result of accident or illness, can no longer be fully employed as befits his/her training and skills for health reasons or is disabled within the meaning of the Federal invalidity insurance, accident insurance or military insurance schemes, and/or is drawing benefits from one or more of these institutions (please attach pension decision).


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