Social Media Form

E-Mail recipient*:
*
Sender*:
*
Your message*:
*

Contact form for cross-border workers

* Required field


Mr Mrs
*
Last Name*:
*
First Name*:
*
Address*:
*
Country*:
*
Potcode*:
*
City*:
*
Birth date*:
Format DD:MM:YYYY
*
Telephone during the day*:
Format 0041445556677
*
E-Mail:
Employer
Company*:
*
Address*:
*
Postcode*:
*
City*:
*
I work more than 8 hours per week
I work less than 8 hours per week
*
Previous insurer
Name of the previous insurer*:
*
Valid work permit
Valid as oft*:
*
Since (year)*:
*
Quotation for ÖKK EUROLINE (statutory health insurance)
By Post
Via e-mail (please indicate e-mail address)
*
Comments: