CSS Your direct contact

Customer Service Center Customer Service Center

P.O. Box 2550 Phone 0844 277 277
6002 Lucerne Monday to Friday, 8 - 18h

info@css.ch
www.css.ch

Mr.
Borislav Vulic
c/o Bomini GmbH
PREMIUM STATEMENT Gliserallee 1
3902 Glis
Client number premium payer: 779-01-516
Statement number: 1813127090
Billing date: 13.05.2023
Payable by: 30.06.2023

Period Monthly Total

from ------------------- to premium premium

Vulic Borislav
Premium Basic insurance (KVG) 01.07.2023 - 31.07.2023 352.50 352.50

Grand total premiums 352.50

You pay CHF 352.50

001-00000-00000-03783-24321

For payments at the post office counter we will pass on the counter fee.

Legal entity for the basic insurance (KVG): CSS Kranken-Versicherung AG

Please use only this payment slip. Do not set up a standing order. Page 1 / 1
353194788 / 1 / 0048674 /0006496831-001/inexkasso/01/d0006_2/3.34.0//en/ 0048674 / 0048674 / 0057682 /%%PRDEV%%

Receipt Payment part Account / Payable to

CH88 3000 0001 6000 1125 9
Account / Payable to
CSS Kranken-Versicherung AG Hauptsitz
CH88 3000 0001 6000 1125 9
CSS Kranken-Versicherung AG Hauptsitz Tribschenstrasse 21
Tribschenstrasse 21 6002 Luzern
6002 Luzern
Reference
Reference
00 00007 79015 16001 81312 70906
00 00007 79015 16001 81312 70906

Payable by Payable by
Borislav Vulic Borislav Vulic
Gliserallee 1 Gliserallee 1
3902 Glis
3902 Glis
779-01-516
01.07.2023 - 31.07.2023

Currency Amount Currency Amount

CHF 352.50 CHF 352.50

Acceptance point