Freedom Life - Capital

Information about the insured person

IIN of the insured

Full name

ҚР резиденті

Date of birth

Place of birth

Phone number

Phone Number (Optional)

Phone number (Work)

E-mail

Residential address: city, street, house, apt.

Street

Microdistrict

House

Apartment

Postal code

ID document

Number/Series

Date of issue

Workplace

Job position

Workplace

Position held and precise job description