Change of address Disability insurance •You can use this form to inform us of a change in your address. •Questions? Feel free to call +31 (0)45 579 61 11. 90.0015.14A.en Loyalis Leven N.V. with its registered office in Heerlen is registered in the Limburg Chamber of Commerce trade register under number 14053379. AFM permit number 12000433. ISO 9001:2008 certified. Loyalis Schade N.V. has its registered office in Heerlen and is registered in the Limburg Chamber of Commerce trade register under number 14053380. AFM permit number 12000632. ISO 9001:2008 certified. PERSONAL INFORMATION Birth name Initials Male Female Do you have a partner? No Yes, partner name By which name(s) would you like us to address you? Street and house nr.* * Including any suffix Postal code City/town Country Date of birth Citizen service nr. Nationality Dutch Other, specifically Email Telephone Account or customernr.* * You can find this number on your certificate or policy. CHANGE OF ADDRESS (residential) Date of change Street and house nr.* * Including any suffix Postal code City/town Country CHANGE OF ADDRESS (correspondence) Date of change Street and house nr.* Postal code Country * Including any suffix City/town SIGNATURE The undersigned declares that he/she has completed this form truthfully. Date City/town Signature Return to: oyalis Verzekeringen L Antwoordnummer 4041 6400 VC Heerlen The Netherlands
© Copyright 2024 ExpyDoc
![問題用紙No.1及び採点資料 [PDFファイル／935KB]](http://s3.expydoc.com/store/data/007427049_1-28b1697ab6949cbb8afe2be68a1b13a1-250x500.png)
