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RESOLUTION OF THE CABINET OF MINISTERS OF THE AZERBAIJAN REPUBLIC

of August 19, 1997 No. 94

About approval of form of the certificate (policy) of voluntary (additional) social insurance

(as amended of the Resolution of the Cabinet of Ministers of the Azerbaijan Republic of 22.06.2016 No. 242)

According to the Presidential decree of the Azerbaijan Republic "About application of the Law of the Azerbaijan Republic" "About social insurance" of April 7, 1997 the No. 568 Cabinet of Ministers of the Azerbaijan Republic decides: Approve form of the certificate (policy) of voluntary (additional) social insurance it (is applied).

Prime Minister of the Azerbaijan Republic

A. Rasi-Zade

Approved by the Resolution of the Cabinet of Ministers of the Azerbaijan Republic of August 19, 1997
, No. 94

 
                       Азербайджанская Республика
______________________________________________________________________
(наименование организации социального страхования)

Policy of voluntary (additional) social insurance

Вид добровольного
социального страхования _________________
Застрахованный                         Договор страхования
Фамилия _____________________________ Дата заключения ______________
Имя __________________________________ Срок _________________________
Отчество _____________________________ Страховая сумма ______________
Дата рождения ________________________ Месячный страховой взнос _____
Место работы _________________________ Страховой случай _____________
Адрес ________________________________
Индивидуальный идентификационный номер ______________________________
Наследник (в пользу которого заключен  Уплата страхового взноса
договор страхования)
Фамилия _____________________________ Наличными ____________________
Имя _________________________________ Безналично ___________________
Отчество _____________________________ Дата уплаты __________________
Срок действия страхового полиса____________________________
Оговорки ________________________________________________
Руководитель _____________________
(подпись)
Застрахованный
(Страхователь) ____________________
(подпись)
"____" ________________ 199__ ил.

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