Step 2: Swiss Check Form for Health Equivalency

Step 3: Submit the Swiss Check Form - Due April 26th

Swiss Check Form for Health Insurance Equivalency

Please complete the Swiss Check Form for Health Insurance Equivalency by following the link below. Note: some information has been entered for you.

• Swiss Check Form for Health Insurance Equivalency (PDF)

INSTRUCTIONS

1. Download the form and TYPE the following information in Part 1: last name, first name, phone number, email address, date of birth, nationality, your sex, and marital status.

2. Leave type of permit blank, but list that it will be valid from August 2024, and that your stay in Switzerland will end in December 2024.

3. Leave Part 2 blank.

4. Print both pages of this form double-sided, and sign and date the box labeled "signature of policyholder" in the middle of the page at the bottom of Part 2. DO NOT sign at the bottom of the page where it says "Stamp/seal and signature of insurer."

5. Submit completed form  via email to Lisa Johnson (ldjohnson@smith.edu).