APPLICATION FOR INSURANCE PRODUCTS

1.Personal data:

Name:

Father:

Surname:

Gender:

Birthday:

Profession (your actual job and institution):

Your Residence:

ID No.:

Email:

Phone:

Address: (administrative unit, street, appartment no., city, state)

2.Insurance product you are applying for:



I confirm the completion and the accuracy of the above given data and I authorize SiCRED sh.a. to process my personal data for internal use of SiCRED sh.a.*

*Disclaimer:

SiCRED sh.a., guarantees that the data collected using this application, will be processed in full compliance with the predictions of the Law no. 9887 dated 10.03.2008 "On personal data protection" (as amended). As the subject of these data, you have all the right as prevised by the law. SiCRED sh.a., have in place a high standard security system for storing and further processing of these data.