Page 1

PASSAGE ST-ANTOINE 7 | CP | CH – 1800 VEVEY 1

NOTICE OF EXIT

T 021 924 87 40 | F 021 924 87 07 COPRE@COPRE.CH | WWW.COPRE.CH

co re LA COLLECTIVE DE PRÉVOYANCE D E P U I S 1 974

Company :

Contract n° :

Personal data of the insured Name and first name :

Date of birth :

AVS N° :

Sex :

masculine

feminine

Address : Civil status :

bachelor

married

bound by a registered partnership

divorced

widow(er)

dissolved partnership

Information concerning exit Date of exit (salary paid until) : Is the insured incapacitated for work resulting from an illness or accident?

yes

no

If yes, give some details (dates, causes, etc.) :

Place and date :

Stamp, signature of employer : 

If already in possession of the necessary items for his exit benefit, the insured may here and now complete the form overleaf

Notice of exit  |   January 2014  |  page 1/2


co re LA COLLECTIVE DE PRÉVOYANCE D E P U I S 1 974

Personal data of the insured Name and first name :

Date of birth :

Information concerning the transfer Please transfer my vested benefit to the pension institution of my new employer or to a vested benefit account/policy.

Name and address of the new pension institution or vested benefit foundation :

Name and address of the new employer :

Address for payment (Please attach a payment slip or the bank identifier document)

IBAN (max. 34 figures) : Bank / Post Office : (Name, npa, place, country) :

Account holder :

I declare that all the information provided above is in conformity with the truth.

Place and date :

Signature of the insured person : 

For a payment in cash, please request the relevant form

Notice of exit  |   January 2014  |  page 2/2

Notice of exit  
Read more
Read more
Similar to
Popular now
Just for you