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Payer information
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Company / third party / hospital
Person / hospital:
Street / house No:
Town / City
Country:
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Virgin Islands (U.S.)
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Bahamas (the)
Bahrain
Bangladesh
Barbados
Belgium
Belize
Belarus
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory (the)
Virgin Islands (British)
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cook Islands (the)
Curaçao
Chad
Montenegro
Czechia
China
Denmark
Dominica
Dominican Republic (the)
Djibouti
Egypt
Ecuador
Eritrea
Estonia
Ethiopia
Faroe Islands (the)
Falkland Islands (the) (Malvinas)
Fiji
Philippines (the)
Finland
France
French Guiana
French Southern Territories (the)
French Polynesia
Gabon
Gambia (the)
Ghana
Gibraltar
Grenada
Greenland
Georgia
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Chile
Croatia
India
Indonesia
Iraq
Iran (Islamic Republic of)
Ireland
Iceland
Italy
Israel
Jamaica
Japan
Yemen
Jersey
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Jordan
Cayman Islands (the)
Cambodia
Cameroon
Canada
Cabo Verde
Qatar
Kazakhstan
Kenya
Kiribati
Cocos (Keeling) Islands (the)
Colombia
Comoros (the)
Congo (the Democratic Republic of the)
Congo (the)
Korea (the Democratic People's Republic of)
Korea (the Republic of)
Costa Rica
Cuba
Kuwait
Cyprus
Kyrgyzstan
Lao People's Democratic Republic (the)
Lesotho
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Latvia
Luxembourg
Macao
Madagascar
Hungary
Malaysia
Malawi
Maldives
Mali
Malta
Isle of Man
Morocco
Marshall Islands (the)
Martinique
Mauritius
Mauritania
Mayotte
United States Minor Outlying Islands (the)
Mexico
Micronesia (Federated States of)
Moldova (the Republic of)
Monaco
Mongolia
Montserrat
Mozambique
Myanmar
Namibia
Nauru
Germany
Nepal
Niger (the)
Nigeria
Nicaragua
Niue
Netherlands (the)
Norfolk Island
Norway
New Caledonia
New Zealand
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Pitcairn
Côte d'Ivoire
Poland
Puerto Rico
Portugal
Austria
Réunion
Equatorial Guinea
Romania
Russian Federation (the)
Rwanda
Greece
Saint Pierre and Miquelon
El Salvador
Samoa
San Marino
Saudi Arabia
Senegal
North Macedonia
Northern Mariana Islands (the)
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Somalia
United Arab Emirates (the)
United States of America (the)
Serbia
Central African Republic (the)
Sudan (the)
Suriname
Saint Helena, Ascension and Tristan da Cunha
Saint Lucia
Saint Barthélemy
Saint Kitts and Nevis
Saint Martin (French part)
Sint Maarten (Dutch part)
Sao Tome and Principe
Saint Vincent and the Grenadines
Eswatini
Syrian Arab Republic (the)
Solomon Islands
Spain
Svalbard and Jan Mayen
Sri Lanka
Sweden
Switzerland
Tajikistan
Tanzania, the United Republic of
Thailand
Taiwan
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Turks and Caicos Islands (the)
Tuvalu
Uganda
Ukraine
Uruguay
Uzbekistan
Christmas Island
Vanuatu
Holy See (the)
United Kingdom of Great Britain and Northern Ireland (the)
Venezuela (Bolivarian Republic of)
Viet Nam
Timor-Leste
Wallis and Futuna
Zambia
Western Sahara
Zimbabwe
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