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Insured event
7775
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Insured event
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7775
Freedom-Optimal
Добровольное онлайн страхование от несчастного случая с покрытием временной нетрудоспособности
Who will we insure/the policyholder?
Program
Program
Enter IIN
Enter IIN
Enter your full name
Enter your full name
Gender
Gender
Date of birth
Date of birth
Phone
Phone
Email to receive the policy:
Email to receive the policy:
Residence address: street, house, apt.
Residence address: street, house, apt.
Document, identifying a person
Document type
Identity card
Document type
Document number
Document number
Date of issue of the document
Date of issue of the document
Issuing Authority:
Issuing Authority:
БИН Страхователя:
БИН Страхователя:
Наименование:
Наименование:
ФИО первого руководителя:
ФИО первого руководителя:
Юрид. Адрес:
Юрид. Адрес:
Банковские реквизиты
Наименование Банка
Наименование Банка
БИК Банка
БИК Банка
ИИК
ИИК
ОКЭД
ОКЭД
ОКЭД
Код сектора экономики
Код сектора экономики
Признак резидентства
Сведения о бенефициарном собственнике
Enter IIN
Enter IIN
Enter your full name
Enter your full name
Дата выдачи документа:
Дата выдачи документа:
Срок действия
Срок действия
Document number
Document number
Issuing Authority:
Issuing Authority:
Insured sum and payment method
Phone - to contact you:
Phone - to contact you:
Email to receive the policy:
Email to receive the policy:
Policy start date
Policy start date
Policy expiration date
Policy expiration date
Тариф:
Тариф:
Insured sum:
Insured sum:
To pay:
To pay:
I confirm compliance and consent with the terms
of declarations
I give my consent for collection and processing of personal data and I am familiar with the
Insurance rules are available for review on the Internet resource:
www.solva.kz
Pay
