www.swica.ch
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urlscan Pro
159.168.141.78
Public Scan
Submitted URL: http://contacts.swica.ch/
Effective URL: https://www.swica.ch/en/private/contact
Submission: On July 18 via api from CH — Scanned from DE
Effective URL: https://www.swica.ch/en/private/contact
Submission: On July 18 via api from CH — Scanned from DE
Form analysis 3 forms found in the DOM
<form class="swc-nav-search-input__form"><input type="search" data-swc-nav-search-input="input" aria-label="Search" placeholder="Search term" class="swc-nav-search-input__input"> <button type="submit" data-swc-nav-search-input="submit" value="Search"
class="swc-nav-search-input__button"><svg class="swc-nav-search-input__icon">
<use href="#swc_search_icon"></use>
</svg></button></form>POST /private/contact
<form action="/private/contact" data-sc-fxb="4471315a-abe3-45d1-8d45-87523cf93024" enctype="multipart/form-data" id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_4471315a-abe3-45d1-8d45-87523cf93024" method="post" novalidate="novalidate"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_FormSessionId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.FormSessionId" type="hidden" value="86f7e08d-d8bf-4e27-ad17-385969299da1"><input name="__RequestVerificationToken" type="hidden"
value="dCSqVNRG106kRtIMbRwwo2SIZ2ovVpz5SqhT1QqkccNw6ExvYydskKLR-ncNTFPfSIZeo_Mpa5sNiXjA1IkVMU9bbGPjjdWU5fTsJHt67W81"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_FormItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.FormItemId"
type="hidden" value="4471315a-abe3-45d1-8d45-87523cf93024"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_PageItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.PageItemId" type="hidden" value="81b87ddf-5db8-478d-af47-87b16bcf0f95">
<input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_ffeac87a-0289-434a-aeed-75a7ea113773" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="ffeac87a-0289-434a-aeed-75a7ea113773"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_ffeac87a-0289-434a-aeed-75a7ea113773__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[ffeac87a-0289-434a-aeed-75a7ea113773].ItemId" type="hidden"
value="ffeac87a-0289-434a-aeed-75a7ea113773">
<div class="element">
<div class="swc-textarea"><label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_ffeac87a-0289-434a-aeed-75a7ea113773__Value" class="swc-textarea-control__label">My query</label>
<div class="swc-textarea-control"><textarea id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_ffeac87a-0289-434a-aeed-75a7ea113773__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[ffeac87a-0289-434a-aeed-75a7ea113773].Value"
autocomplete="off" rows="4" maxlength="3000" data-sc-tracking="False" data-sc-field-name="bemerkungen" data-sc-field-key="1D03F1992FCA4AC6BDE2098CC83E914A" data-val-length="My query must have at least 0 and no more than 3000 characters."
data-val-length-max="3000" data-val-regex="The field contains invalid special characters (e.g. "<" or ">"). These characters must be deleted before you can send off the form." data-val-regex-pattern="^[^<>]*$"
data-val="true" class="swc-textarea-control__textarea swc-textarea-control--error"></textarea> <span><small class="@Html.CustomValidationMessageFor(m => Model.Value, null, errorSmallClasses)"><span
data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[ffeac87a-0289-434a-aeed-75a7ea113773].Value" data-valmsg-replace="true" class="field-validation-valid"></span></small></span></div>
</div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_ddb72053-c170-4cc9-a22b-8abd76f82c27" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="ddb72053-c170-4cc9-a22b-8abd76f82c27"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_ddb72053-c170-4cc9-a22b-8abd76f82c27__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[ddb72053-c170-4cc9-a22b-8abd76f82c27].ItemId" type="hidden"
value="ddb72053-c170-4cc9-a22b-8abd76f82c27">
<div class="element">
<div class="swc-radio-list is-clearfix "><span class="swc-field__question">SWICA customer *</span>
<div class="swc-field"><input type="radio" id="{3EC80352-0ED3-4ABA-98E2-15DD549B9345}" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[ddb72053-c170-4cc9-a22b-8abd76f82c27].Value" value="yes_hf_1" data-sc-tracking="False"
data-sc-field-name="kunde" data-sc-field-key="130540DD844F4AAABA4D5F131BB8B493" data-val-required="SWICA customer * must be filled in" data-val="true" class="swc-field--radio is-checkradio"> <label for="option_example"
class="swc-input--radio-has-label"> Yes</label></div>
<div class="swc-field"><input type="radio" id="{2EC4ED30-2889-4636-A36F-E0323F9C78C8}" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[ddb72053-c170-4cc9-a22b-8abd76f82c27].Value" value="no_hf_2" data-sc-tracking="False"
data-sc-field-name="kunde" data-sc-field-key="130540DD844F4AAABA4D5F131BB8B493" class="swc-field--radio is-checkradio"> <label for="option_example" class="swc-input--radio-has-label"> No</label></div>
</div>
</div> <span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[ddb72053-c170-4cc9-a22b-8abd76f82c27].Value" data-valmsg-replace="true" class="field-validation-valid"></span> <input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_e3780474-45eb-4ab7-b49b-9cce889bd93d" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="e3780474-45eb-4ab7-b49b-9cce889bd93d"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_e3780474-45eb-4ab7-b49b-9cce889bd93d__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[e3780474-45eb-4ab7-b49b-9cce889bd93d].ItemId" type="hidden"
value="e3780474-45eb-4ab7-b49b-9cce889bd93d"> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_e3780474-45eb-4ab7-b49b-9cce889bd93d__Value"
name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[e3780474-45eb-4ab7-b49b-9cce889bd93d].Value" type="hidden" value="b04i01s00" data-sc-tracking="False" data-sc-field-name="mailCodierung_kunde_hf_1"
data-sc-field-key="7293502993EB4377B31593CD57535997"> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_93af44af-8180-42d8-9e8b-acc5c0ded8ef" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden"
value="93af44af-8180-42d8-9e8b-acc5c0ded8ef"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_93af44af-8180-42d8-9e8b-acc5c0ded8ef__ItemId"
name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[93af44af-8180-42d8-9e8b-acc5c0ded8ef].ItemId" type="hidden" value="93af44af-8180-42d8-9e8b-acc5c0ded8ef"> <input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_93af44af-8180-42d8-9e8b-acc5c0ded8ef__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[93af44af-8180-42d8-9e8b-acc5c0ded8ef].Value" type="hidden" value="b03i01s00"
data-sc-tracking="False" data-sc-field-name="mailCodierung_kunde_hf_2" data-sc-field-key="7F12DD43B26A47659305B05C56171B20">
<div data-sc-field-key="A47CBC43E71448328D46165B52F79D87"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_3d36d64b-af6e-4f70-b8d2-dbaf413e037a" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden"
value="3d36d64b-af6e-4f70-b8d2-dbaf413e037a"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_3d36d64b-af6e-4f70-b8d2-dbaf413e037a__ItemId"
name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[3d36d64b-af6e-4f70-b8d2-dbaf413e037a].ItemId" type="hidden" value="3d36d64b-af6e-4f70-b8d2-dbaf413e037a">
<div class="element">
<div data-select-label="Title" data-select-multiple="false" data-select-placeholder="Title" data-select-disabled="false" data-select-name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[3d36d64b-af6e-4f70-b8d2-dbaf413e037a].Value"
data-select-id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_3d36d64b-af6e-4f70-b8d2-dbaf413e037a__Value" data-select-sc-tracking="False" data-select-sc-field-key="0D7DE935EDEA471E83C20FE319132776"
class="swc-select dropdown swc-shadow swc-shadow--primary swc-select__form">
<div class="swc-select__trigger dropdown-trigger">
<div class="swc-input-control"><input readonly="readonly" placeholder="Title" value="Ms" data-trigger=""
class="swc-input-control__input swc-input-control__input--disable-typing swc-input-control__input--has-placeholder swc-input-control__input--has-value"> <label
class="swc-input-control__label swc-input-control__label--has-placeholder swc-input-control__label--has-value" style="margin-top: -14px;">Title</label> <span data-trigger-icon="" class="icon is-small swc-select__icon"><img
src="/assets/icons/swc_chevron_down_icon.svg" alt=""></span></div>
</div>
<div role="menu" class="swc-select__menu dropdown-menu">
<div class="swc-select__content dropdown-content">
<ul class="swc-select__list">
<li data-value="w" data-title="Ms" data-selected="True" class="swc-select__list__item"> Ms </li>
<li data-value="m" data-title="Mr" data-selected="False" class="swc-select__list__item"> Mr </li>
</ul> <input disabled="disabled" type="hidden" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[3d36d64b-af6e-4f70-b8d2-dbaf413e037a].Value" value="w">
</div>
</div> <select id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_3d36d64b-af6e-4f70-b8d2-dbaf413e037a__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[3d36d64b-af6e-4f70-b8d2-dbaf413e037a].Value" data-sc-tracking="False"
data-sc-field-key="0D7DE935EDEA471E83C20FE319132776" style="display: none;">
<option value="w" selected="selected"> Ms </option>
<option value="m"> Mr </option>
</select>
</div>
</div><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_76b44772-8dd9-47fb-9808-c430a5a210c5" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="76b44772-8dd9-47fb-9808-c430a5a210c5"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_76b44772-8dd9-47fb-9808-c430a5a210c5__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[76b44772-8dd9-47fb-9808-c430a5a210c5].ItemId" type="hidden"
value="76b44772-8dd9-47fb-9808-c430a5a210c5">
<div class="element inline-first inline-50">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_76b44772-8dd9-47fb-9808-c430a5a210c5__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[76b44772-8dd9-47fb-9808-c430a5a210c5].Value"
type="text" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="vorname" data-sc-field-key="48C41FF074FF4BD4868C7F4518BC03DC"
data-val-length="First name * must have at least 0 and no more than 255 characters." data-val-length-max="255"
data-val-regex="The field contains invalid special characters (e.g. "<" or ">"). These characters must be deleted before you can send off the form." data-val-regex-pattern="^[^<>]*$"
data-val-required="First name * must be filled in" data-val="true" class="swc-input-control__input"> <label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_76b44772-8dd9-47fb-9808-c430a5a210c5__Value" class="swc-input-control__label"
style="margin-top: 8px;">First name *</label> <span><small class="swc-input-control__error"><span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[76b44772-8dd9-47fb-9808-c430a5a210c5].Value" data-valmsg-replace="true"
class="field-validation-valid"></span></small></span></div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_fa565f4b-ba41-4dc6-90a6-7dea794bad7d" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="fa565f4b-ba41-4dc6-90a6-7dea794bad7d"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_fa565f4b-ba41-4dc6-90a6-7dea794bad7d__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[fa565f4b-ba41-4dc6-90a6-7dea794bad7d].ItemId" type="hidden"
value="fa565f4b-ba41-4dc6-90a6-7dea794bad7d">
<div class="element inline-last inline-50">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_fa565f4b-ba41-4dc6-90a6-7dea794bad7d__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[fa565f4b-ba41-4dc6-90a6-7dea794bad7d].Value"
type="text" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="name" data-sc-field-key="E10D0650CAEC4BBC894E26597205CED5" data-val-length="Surname * must have at least 0 and no more than 255 characters."
data-val-length-max="255" data-val-regex="The field contains invalid special characters (e.g. "<" or ">"). These characters must be deleted before you can send off the form." data-val-regex-pattern="^[^<>]*$"
data-val-required="Surname * must be filled in" data-val="true" class="swc-input-control__input"> <label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_fa565f4b-ba41-4dc6-90a6-7dea794bad7d__Value" class="swc-input-control__label"
style="margin-top: 8px;">Surname *</label> <span><small class="swc-input-control__error"><span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[fa565f4b-ba41-4dc6-90a6-7dea794bad7d].Value" data-valmsg-replace="true"
class="field-validation-valid"></span></small></span></div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_33a48893-cea5-4bb8-8122-bced54da21ca" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="33a48893-cea5-4bb8-8122-bced54da21ca"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_33a48893-cea5-4bb8-8122-bced54da21ca__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[33a48893-cea5-4bb8-8122-bced54da21ca].ItemId" type="hidden"
value="33a48893-cea5-4bb8-8122-bced54da21ca">
<div class="element ">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_33a48893-cea5-4bb8-8122-bced54da21ca__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[33a48893-cea5-4bb8-8122-bced54da21ca].Value"
type="text" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="geburtsdatum" data-sc-field-key="EF1FDF7BD089493C97E4DDA1AA376FE4" data-val-regex="Date of birth (dd.mm.yyyy) * has invalid format."
data-val-regex-pattern="^([0-2][0-9]|(3)[0-1]|[0-9])(\.)(((0)[0-9])|((1)[0-2])|[0-9])(\.)\d{4}$" data-val-timespanageolder="Please enter a valid birth year." data-val-timespanageolder-max="120" data-val-timespanageolder-unit="years"
data-val-timespanageyounger="The date can be a maximum of 1 year in the future." data-val-timespanageyounger-min="-1" data-val-timespanageyounger-unit="years" data-val-required="Date of birth (dd.mm.yyyy) * must be filled in"
data-val="true" class="swc-input-control__input"> <label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_33a48893-cea5-4bb8-8122-bced54da21ca__Value" class="swc-input-control__label" style="margin-top: 8px;">Date of birth (dd.mm.yyyy)
*</label> <span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[33a48893-cea5-4bb8-8122-bced54da21ca].Value" data-valmsg-replace="true" class="field-validation-valid"></span></div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_c34b41e0-85e5-4840-9090-e33ad5ce2b32" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="c34b41e0-85e5-4840-9090-e33ad5ce2b32"><input
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value="c34b41e0-85e5-4840-9090-e33ad5ce2b32">
<div class="element ">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_c34b41e0-85e5-4840-9090-e33ad5ce2b32__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[c34b41e0-85e5-4840-9090-e33ad5ce2b32].Value"
type="text" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="strasse" data-sc-field-key="F56249C512D54719A76380E5B8A6FDE2"
data-val-length="Street/no. * must have at least 0 and no more than 255 characters." data-val-length-max="255"
data-val-regex="The field contains invalid special characters (e.g. "<" or ">"). These characters must be deleted before you can send off the form." data-val-regex-pattern="^[^<>]*$"
data-val-required="Street/no. * must be filled in" data-val="true" class="swc-input-control__input"> <label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_c34b41e0-85e5-4840-9090-e33ad5ce2b32__Value" class="swc-input-control__label"
style="margin-top: 8px;">Street/no. *</label> <span><small class="swc-input-control__error"><span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[c34b41e0-85e5-4840-9090-e33ad5ce2b32].Value" data-valmsg-replace="true"
class="field-validation-valid"></span></small></span></div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_2b398b83-ac4d-457b-9adb-84dcfd02f8f6" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="2b398b83-ac4d-457b-9adb-84dcfd02f8f6"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_2b398b83-ac4d-457b-9adb-84dcfd02f8f6__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[2b398b83-ac4d-457b-9adb-84dcfd02f8f6].ItemId" type="hidden"
value="2b398b83-ac4d-457b-9adb-84dcfd02f8f6">
<div class="element inline-first inline-25">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_2b398b83-ac4d-457b-9adb-84dcfd02f8f6__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[2b398b83-ac4d-457b-9adb-84dcfd02f8f6].Value"
type="text" value="" maxlength="255" data-sc-tracking="False" data-sc-field-name="plz" data-sc-field-key="29902063A05B4E30BCC0AE55B0D546A8" data-val-regex="has invalid format" data-val-regex-pattern="^[0-9]{4,5}$"
data-val-required="Postcode * must be filled in" data-val="true" class="swc-input-control__input"> <label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_2b398b83-ac4d-457b-9adb-84dcfd02f8f6__Value" class="swc-input-control__label"
style="margin-top: 8px;">Postcode *</label> <span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[2b398b83-ac4d-457b-9adb-84dcfd02f8f6].Value" data-valmsg-replace="true" class="field-validation-valid"></span></div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_a3af57a0-da7e-4d1c-ad07-c75828ba9bd7" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="a3af57a0-da7e-4d1c-ad07-c75828ba9bd7"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_a3af57a0-da7e-4d1c-ad07-c75828ba9bd7__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[a3af57a0-da7e-4d1c-ad07-c75828ba9bd7].ItemId" type="hidden"
value="a3af57a0-da7e-4d1c-ad07-c75828ba9bd7">
<div class="element inline-last inline-75">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_a3af57a0-da7e-4d1c-ad07-c75828ba9bd7__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[a3af57a0-da7e-4d1c-ad07-c75828ba9bd7].Value"
type="text" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="ort" data-sc-field-key="3639416B13D34A9F8618B6180212EE28" data-val-length="Town * must have at least 0 and no more than 255 characters."
data-val-length-max="255" data-val-regex="The field contains invalid special characters (e.g. "<" or ">"). These characters must be deleted before you can send off the form." data-val-regex-pattern="^[^<>]*$"
data-val-required="Town * must be filled in" data-val="true" class="swc-input-control__input"> <label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_a3af57a0-da7e-4d1c-ad07-c75828ba9bd7__Value" class="swc-input-control__label"
style="margin-top: 8px;">Town *</label> <span><small class="swc-input-control__error"><span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[a3af57a0-da7e-4d1c-ad07-c75828ba9bd7].Value" data-valmsg-replace="true"
class="field-validation-valid"></span></small></span></div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_6a1df4e8-1bc4-44f7-915a-3939ff727c35" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="6a1df4e8-1bc4-44f7-915a-3939ff727c35"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_6a1df4e8-1bc4-44f7-915a-3939ff727c35__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[6a1df4e8-1bc4-44f7-915a-3939ff727c35].ItemId" type="hidden"
value="6a1df4e8-1bc4-44f7-915a-3939ff727c35">
<div class="element">
<div data-select-label="Country *" data-select-multiple="false" data-select-placeholder="Country *" data-select-disabled="false" data-select-name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[6a1df4e8-1bc4-44f7-915a-3939ff727c35].Value"
data-select-id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_6a1df4e8-1bc4-44f7-915a-3939ff727c35__Value" data-select-sc-tracking="False" data-select-sc-field-key="214530BDE1184CF0B408C17D501251BE"
class="swc-select dropdown swc-shadow swc-shadow--primary swc-select__form">
<div class="swc-select__trigger dropdown-trigger">
<div class="swc-input-control"><input readonly="readonly" placeholder="Country *" value="CH" data-trigger=""
class="swc-input-control__input swc-input-control__input--disable-typing swc-input-control__input--has-placeholder swc-input-control__input--has-value"> <label
class="swc-input-control__label swc-input-control__label--has-placeholder swc-input-control__label--has-value" style="margin-top: -14px;">Country *</label> <span data-trigger-icon="" class="icon is-small swc-select__icon"><img
src="/assets/icons/swc_chevron_down_icon.svg" alt=""></span></div>
</div>
<div role="menu" class="swc-select__menu dropdown-menu">
<div class="swc-select__content dropdown-content">
<ul class="swc-select__list">
<li data-value="CH" data-title="CH" data-selected="True" class="swc-select__list__item"> CH </li>
<li data-value="A" data-title="A" data-selected="False" class="swc-select__list__item"> A </li>
<li data-value="D" data-title="D" data-selected="False" class="swc-select__list__item"> D </li>
<li data-value="F" data-title="F" data-selected="False" class="swc-select__list__item"> F </li>
<li data-value="FL" data-title="FL" data-selected="False" class="swc-select__list__item"> FL </li>
<li data-value="I" data-title="I" data-selected="False" class="swc-select__list__item"> I </li>
</ul> <input disabled="disabled" type="hidden" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[6a1df4e8-1bc4-44f7-915a-3939ff727c35].Value" value="CH">
</div>
</div> <select id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_6a1df4e8-1bc4-44f7-915a-3939ff727c35__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[6a1df4e8-1bc4-44f7-915a-3939ff727c35].Value" data-sc-tracking="False"
data-sc-field-key="214530BDE1184CF0B408C17D501251BE" style="display: none;">
<option value="CH" selected="selected"> CH </option>
<option value="A"> A </option>
<option value="D"> D </option>
<option value="F"> F </option>
<option value="FL"> FL </option>
<option value="I"> I </option>
</select>
</div>
</div><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_5ef043d3-7a63-46a3-8772-942d5bd98690" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="5ef043d3-7a63-46a3-8772-942d5bd98690"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_5ef043d3-7a63-46a3-8772-942d5bd98690__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[5ef043d3-7a63-46a3-8772-942d5bd98690].ItemId" type="hidden"
value="5ef043d3-7a63-46a3-8772-942d5bd98690">
<div class="element inline-first inline-50">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_5ef043d3-7a63-46a3-8772-942d5bd98690__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[5ef043d3-7a63-46a3-8772-942d5bd98690].Value"
type="text" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="telefon" data-sc-field-key="523974FC76DD468B9C5AA4169DB54E87" data-val-length="Phone * must have at least 0 and no more than 255 characters."
data-val-length-max="255" data-val-regex="The field contains invalid special characters (e.g. "<" or ">"). These characters must be deleted before you can send off the form." data-val-regex-pattern="^[^<>]*$"
data-val-required="Phone * must be filled in" data-val="true" class="swc-input-control__input"> <label for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_5ef043d3-7a63-46a3-8772-942d5bd98690__Value" class="swc-input-control__label"
style="margin-top: 8px;">Phone *</label> <span><small class="swc-input-control__error"><span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[5ef043d3-7a63-46a3-8772-942d5bd98690].Value" data-valmsg-replace="true"
class="field-validation-valid"></span></small></span></div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_f24d9bfa-ba0b-40a3-b57c-b665416794ec" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="f24d9bfa-ba0b-40a3-b57c-b665416794ec"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_f24d9bfa-ba0b-40a3-b57c-b665416794ec__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[f24d9bfa-ba0b-40a3-b57c-b665416794ec].ItemId" type="hidden"
value="f24d9bfa-ba0b-40a3-b57c-b665416794ec">
<div class="element inline-last inline-50">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_f24d9bfa-ba0b-40a3-b57c-b665416794ec__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[f24d9bfa-ba0b-40a3-b57c-b665416794ec].Value"
type="email" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="email" data-sc-field-key="50E9183CE5564FD0A5B5C7B188B7D458" data-val-regex="Please enter a valid email address."
data-val-regex-pattern="^[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,17}$" data-val-required="Email * must be filled in" data-val="true" class="swc-input-control__input"> <label
for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_f24d9bfa-ba0b-40a3-b57c-b665416794ec__Value" class="swc-input-control__label" style="margin-top: 8px;">Email *</label> <span
data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[f24d9bfa-ba0b-40a3-b57c-b665416794ec].Value" data-valmsg-replace="true" class="field-validation-valid"></span></div>
</div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_7e898148-d3a6-4793-922b-091f9d2e2d56" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="7e898148-d3a6-4793-922b-091f9d2e2d56"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_7e898148-d3a6-4793-922b-091f9d2e2d56__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[7e898148-d3a6-4793-922b-091f9d2e2d56].ItemId" type="hidden"
value="7e898148-d3a6-4793-922b-091f9d2e2d56">
<div class="element">
<div class="swc-radio-list is-clearfix "><span class="swc-field__question">Please contact me by *</span>
<div class="swc-field"><input type="radio" id="{7A56E333-679A-4369-873F-D341ABDB6D62}" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[7e898148-d3a6-4793-922b-091f9d2e2d56].Value" value="tel" data-sc-tracking="False"
data-sc-field-name="kontaktErwuenscht" data-sc-field-key="C4C18FAF3011458194FD7EAAD8CF7715" data-val-required="Please contact me by * must be filled in" data-val="true" class="swc-field--radio is-checkradio"> <label for="option_example"
class="swc-input--radio-has-label"> phone</label></div>
<div class="swc-field"><input type="radio" id="{54DF6678-2C7A-4DA4-A9C7-EAF13EDA4B45}" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[7e898148-d3a6-4793-922b-091f9d2e2d56].Value" value="email" data-sc-tracking="False"
data-sc-field-name="kontaktErwuenscht" data-sc-field-key="C4C18FAF3011458194FD7EAAD8CF7715" class="swc-field--radio is-checkradio"> <label for="option_example" class="swc-input--radio-has-label"> email</label></div>
</div>
</div> <span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[7e898148-d3a6-4793-922b-091f9d2e2d56].Value" data-valmsg-replace="true" class="field-validation-valid"></span>
<div data-sc-field-key="78D4F890B77D41259E498B95548723FB" class="is-mutated" style="display: none;"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_f198b65b-d65a-4876-bad3-88054814cb4b"
name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="f198b65b-d65a-4876-bad3-88054814cb4b"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_f198b65b-d65a-4876-bad3-88054814cb4b__ItemId"
name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[f198b65b-d65a-4876-bad3-88054814cb4b].ItemId" type="hidden" value="f198b65b-d65a-4876-bad3-88054814cb4b">
<div class="element ">
<div class="swc-input-control"><input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_f198b65b-d65a-4876-bad3-88054814cb4b__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[f198b65b-d65a-4876-bad3-88054814cb4b].Value"
type="text" value="" maxlength="255" placeholder="" data-sc-tracking="False" data-sc-field-name="rueckrufzeit" data-sc-field-key="EC11BCE84AAB40679C3FB8F7EC8B33DA"
data-val-length="Available from – to must have at least 0 and no more than 255 characters." data-val-length-max="255"
data-val-regex="The field contains invalid special characters (e.g. "<" or ">"). These characters must be deleted before you can send off the form." data-val-regex-pattern="^[^<>]*$" data-val="true"
class="swc-input-control__input"><input type="hidden" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[f198b65b-d65a-4876-bad3-88054814cb4b].Required" value="false" data-sc-conditions-required=""> <label
for="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_f198b65b-d65a-4876-bad3-88054814cb4b__Value" class="swc-input-control__label">Available from – to</label> <span><small class="swc-input-control__error"><span
data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[f198b65b-d65a-4876-bad3-88054814cb4b].Value" data-valmsg-replace="true" class="field-validation-valid"></span></small></span></div>
</div>
<div class="element">
<p data-sc-field-key="CB21C59B3EEF478C8D0C9B02F52956A7">Calls are returned during business hours.</p>
</div>
</div>
<div data-sc-field-key="2A00506925DA470F88B9391888047F8A" style="display: none;">
<div class="element">
<p data-sc-field-key="147C28473868471B9ACE867E365E2D5F">A reply will be given during business hours.</p>
</div>
</div> <input id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_Index_018d6293-c6a2-4b21-9062-30b81ee8c150" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields.Index" type="hidden" value="018d6293-c6a2-4b21-9062-30b81ee8c150"><input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_018d6293-c6a2-4b21-9062-30b81ee8c150__ItemId" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[018d6293-c6a2-4b21-9062-30b81ee8c150].ItemId" type="hidden"
value="018d6293-c6a2-4b21-9062-30b81ee8c150">
<div id="sitecore-recaptcha" data-hl="en">
<script src="https://www.google.com/recaptcha/api.js?hl=en" defer="" async=""></script>
</div>
<div class="element">
<div data-sitekey="6LcV1qoUAAAAAAyKhIq1VpeLgTWH6cSmha3dkVmN" data-callback="captchaCallback" class="g-recaptcha">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LcV1qoUAAAAAAyKhIq1VpeLgTWH6cSmha3dkVmN&co=aHR0cHM6Ly93d3cuc3dpY2EuY2g6NDQz&hl=en&v=iZWPJyR27lB0cR4hL_xOX0GC&size=normal&cb=ym5kkwvzl6jd" width="304"
height="78" role="presentation" name="a-6buu2cevj06k" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div>
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div> <span id="captchaError-fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_018d6293-c6a2-4b21-9062-30b81ee8c150__Value" class="field-validation-error" style="display: none;">Please verify that you are not a robot.</span> <input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_Fields_018d6293-c6a2-4b21-9062-30b81ee8c150__Value" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[018d6293-c6a2-4b21-9062-30b81ee8c150].Value" value="" type="hidden" data-sc-tracking="False"
data-sc-field-name="Google Recaptcha" data-val-required="Label must be filled in" data-val="true"> <span data-valmsg-for="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.Fields[018d6293-c6a2-4b21-9062-30b81ee8c150].Value" data-valmsg-replace="true"
class="field-validation-valid"></span>
</div>
<div class="element">
<p data-sc-field-key="947F8BEA89424AEB8B855251A61848C7">* Compulsory field </p>
</div>
<div class="element submit">
<div class="swc-button swc-button__input"><input value="Send" type="submit" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.caf3303f-729a-4f96-a73a-5c125a59a551" data-sc-field-key="6999D6368CE44A828D50DC6DFA3DE09A" class="swc-button"></div> <input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_NavigationButtons" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.NavigationButtons" type="hidden" value="caf3303f-729a-4f96-a73a-5c125a59a551"> <input
id="fxb_f2dc1120-90c7-4636-a4aa-3942b2f9d1ec_caf3303f-729a-4f96-a73a-5c125a59a551" name="fxb.f2dc1120-90c7-4636-a4aa-3942b2f9d1ec.caf3303f-729a-4f96-a73a-5c125a59a551" type="hidden" value="0">
</div>
</form><form class="swc-search-input__form"><input id="searchresults" placeholder="Enter search term" aria-label="Enter search term" type="search" data-swc-search-input="input" autocomplete="off" class="swc-search-input__input"> <button
value="Enter search term" type="submit" data-swc-search-input="submit" class="swc-search-input__button"><svg class="swc-search-input__icon">
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Overview 24/7 telemedicine service TytoHome telemedicine device BENECURA app
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psychotherapists Coronavirus Pharmacies Hospitals Show all
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CoronavirusCoronavirus Free servicesFree services Holistic servicesHolistic
services Lists of professionalsLists of professionals Medication
serviceMedication service
* Why SWICA?
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ALWAYS THERE FOR YOU
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Your advantages Holistic services Save and optimise Recommend SWICA
Customer service 24/7 santé24 telemedicine service Emergency at home or
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Personal advicePersonal advice SWICA locationsSWICA locations Customer
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Preventive healthcare Pregnancy and childbirth Good health in old age
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Ask for adviceAsk for advice Premium calculatorPremium calculator Insurance
recommendationInsurance recommendation Service providersService providers
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mySWICA customer portal Modify personal data Change excess Report change of
GP Include or exclude accident Notify a doctor's appointment Report an
accident Show all
Insurance card Tax certificate Insurance policy Bonus programme registration
SWICA promotional items shop
Calculate premium Brochures, forms, GICs SWICA apps Claims and invoices
Frequently Asked Questions / FAQ Medicine Directory Create living wills Show
all
Overview Directory of doctors Directory of hospitals Therapist finder
Pharmacies Fitness centres List of course leaders Show all
* Competition
* Insurance solutions
* Basic insurance
* Overview of basic insurance
* General practitioner model
* Hospital/doctor list model
* Pharmacy model
* HMO model
* Telemedicine
* Free choice of doctor
* Cross-border commuters
* Show all
* Supplementary insurance
* Overview of supplementary insurance
* HOSPITA hospitalisation insurance
* COMPLETA TOP
* COMPLETA PRAEVENTA
* OPTIMA
* SUPPLEMENTA
* Dental insurance
* Accident insurance
* BENEVITA bonus programme
* Show all
* Other insurances
* Overview special insurance
* Pet insurance
* Travel insurance
* Legal protection
* Endowment insurance
* Cross-border commuter insurance
* Insurance cover for people living abroad
* Interim accident insurance
* Guest insurance
* Student insurance
* Show all
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Calculate premiumCalculate premium Insurance recommendationInsurance
recommendation Optimise and saveOptimise and save Advice and contactAdvice
and contact Why SWICA?Why SWICA? DirectoriesDirectories BENEVITABENEVITA
* Health
* World of health
* News and offers
* Health tips
* Discounts active4life
* Competition
* Subscription for newsletter
* Show all
* Health and prevention
* What SWICA supports
* Health promotion
* Prevention offers
* BENEVITA bonus programme
* Maternity
* Good health in old age
* Show all
* BENEVITA Coach
* SymptomCheck app
* Medical support
* Overview
* 24/7 telemedicine service
* TytoHome telemedicine device
* BENECURA app
* Second medical opinion
* Doctors and Health Centres
* Therapists and psychotherapists
* Coronavirus
* Pharmacies
* Hospitals
* Show all
QUICKLINKS
CoronavirusCoronavirus Free servicesFree services Holistic servicesHolistic
services Lists of professionalsLists of professionals Medication
serviceMedication service
* Why SWICA?
* SWICA advantages
* Your advantages
* Holistic services
* Save and optimise
* Recommend SWICA
* Always there for you
* Customer service 24/7
* santé24 telemedicine service
* Emergency at home or abroad
* No. 1 customer satisfaction
* Insurance comparison
* What our customers have to say
QUICKLINKS
Personal advicePersonal advice SWICA locationsSWICA locations Customer
magazineCustomer magazine
* Life topics
* Health and preventive healthcare
* Preventive healthcare
* Pregnancy and childbirth
* Good health in old age
* Coronavirus
* Events
* Hospital stays
* Moving to switzerland
* Reaching adulthood
* Insurance for guests
* Abroad
* Emergency abroad
* Moving abroad
* Spending time abroad
QUICKLINKS
Ask for adviceAsk for advice Premium calculatorPremium calculator Insurance
recommendationInsurance recommendation Service providersService providers
Health programmeHealth programme
* Online services
* Change and report
* mySWICA customer portal
* Modify personal data
* Change excess
* Report change of GP
* Include or exclude accident
* Notify a doctor's appointment
* Report an accident
* Show all
* Order and register
* Insurance card
* Tax certificate
* Insurance policy
* Bonus programme registration
* SWICA promotional items shop
* Other services
* Calculate premium
* Brochures, forms, GICs
* SWICA apps
* Claims and invoices
* Frequently Asked Questions / FAQ
* Medicine Directory
* Create living wills
* Show all
* Directories & Lists
* Overview of directories
* Directory of doctors
* Directory of hospitals
* Therapist finder
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