Notification
English
Lietuvių
English
English
Lietuvių
English
Claims create
Report a bug
Pranešimo siuntimas
×
Contact
Policy Number
*
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Reporter Full Name
*
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Reporter Phone
*
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Reporter Email
*
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Questionaire
Date
×
*
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Description
*
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Employment Status
Please choose
Self employed
Employee of a private/public company
Other
Unemployed
*
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Event type
Please choose
Temporary occupational disability
Job loss
*
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Reason of temporary disability
*
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Required documents
Pasirašytas sutikimas dėl asmens duomenų tvarkymo. Sutikimo formą galite rasti
HERE
. Prašome pasirašyti ir pridėti pateikiant šį pranešimą.
Consent to the processing of personal data
i
Proof of employment – certificate from state authority about Your registration as unemployed or continuation of Your unemployment
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Employment termination evidence, with indicated reason to terminate the employment contract.
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Copy of working time accounting sheet for the last three months in case of Reduction in employment time by more than 50 %.
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Medical report with Doctor’s statement, diagnosis and supporting evidence (i.e. x-ray photo);
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A copy of the certificate for sick leave or any other doctor’s certificate
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Bank account information
Bank Account
*
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Bank
*
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Bank Account Owner Name
*
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Submit
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