Requisites and banking details

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Requisites and banking details

AAS "BTA Baltic Insurance Company" Lithuanian branch:

Company registration number 300665654, Registry manager VĮ Registrų centras
VAT payer's number LT100005808219
Registration address: Viršuliškių skg. 34, LT-05132 Vilnius, Lithuania
Tel.: +370 5 2600 600, fax. +370 5 2102 666, e-mail: bta@bta.lt

Payment information

The following accounts are used for shared payments for BTA insurance policies. The payment order must contain the policy number and the sequence number of the payment.

Bank

SWIFT

Currency

IBAN account number

AB SEB bankas, bank code 70440	CBVILT2X	EUR	LT13 7044 0600 0174 9259
AB Swedbank, bank code 73000	HABALT22	EUR	LT25 7300 0100 0062 6711

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Policy holder‘s driving licence

Vehicle data

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Provision of data

I agree that insurance companies, the State Health Insurance Fund, the State Social Insurance Fund, the Population Register Service, health care and other institutions, as well as physicians and medical personnel and other persons provide my personal data to the Lithuanian Branch of AAS BTA BALTIC INSURANCE COMPANY, as well as data on my health condition at the request of this Company.

Processing of data

I confirm that I am informed and agree that the Lithuanian Branch of AAS BTA BALTIC INSURANCE COMPANY shall process my personal data contained in the health insurance contract application, the health insurance contract and its annexes, notifications on insured event and other documents related to the health insurance contract for the following purposes:
- examining the possibility of concluding an insurance contract and amending the terms and conditions of the concluded contract ;
- assessing the risk of insurance;
- investigating and establishing the fact of the insured event and the amount of the insurance benefit; and;
- providing my personal data to health care institutions and other partners of the Insurer, ensuring the proper implementation of the health insurance contract.
I confirm that I have familiarised myself with the rights and obligations applicable to me under the insurance contract, other terms and conditions of the insurance contract referred to in Health Insurance Rules No 52.2. I undertake not to exceed the limits of sums insured granted to me and the total sum of health insurance

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Policy No.

Accident date

Information

Compensation paid

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Compensation date

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Policy No.

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Card term

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Policy period

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Insured

Policy plan

Payments

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Objects

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Policy limits

Payments

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All invoices are paid

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Paid

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