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The purpose of this Application is to provide the Insurer with the information necessary to conclude the insurance agreement. Completion of the Application does not oblige the Policyholder or the Insurer to conclude an insurance agreement. If an insurance agreement is concluded, this Application shall form an integral part of it.
The Insurer: ERGO Life Insurance SE (reg. No 110707135, address: Geležinio Vilko g. 6A, Vilnius, Lithuania, telephone 1887 or +370 5 268 3222, firstname.lastname@example.org).