Signature of Insured. In case of occurrence of Insured event please immediately contact Savitar Group Assistance Company by phone +000 00 000 00 00 or by e-mail: xxx@xxxxxxx-xx.xxx Annex No.1 to Insurance Contract for persons traveling within Ukraine
Signature of Insured. In case of occurrence of Insured event please immediately contact the L.I.C Assistance: phone: + 00 000 000 00 00; e-mail: xxxx@xxx.xxxx.xx Annex No.1 to Insurance Contract for persons traveling within Ukraine
Signature of Insured. Signature of Legal representative: (For a minor under the age of 7 or a person with no capacity, his/her legal representative shall sign and sign on his/her behalf; for a person above the age of 7 but has not attained the age of 20, he/she and his/her legal representative shall both sign.) Signature of Designated Person: ID Card No.: Phone No.: ( ID Card No. is not required if the designated person is an agent ) Certificate No. of Agent: Agent Code: For Bancassurance only Branch/Name of Branch: Signature of sales representative: Employee No.: (If agent accept the appointment of the Principal, the agent should present to bear witness as the Proposer/Insured/legal representative sign this form in person.) ※To ensure your rights and interests relevant to this application, we may call or visit you for confirmation if necessary! < Page 1.＞POS 2020-11 “Policy Loan Regulations”
