REGISTRATION AND APPLICATION FORM
Registration date: 29.04.2021
Organisation Information
Organisation number 70009770
Organisation name Tervise ja Heaolu Infosüsteemide Keskus
Address Uus-Tatari tn 25
EE-10134 Kesklinna linnaosa
Telephone number +372 7943900
The person who will sign the contract (Contract Signer)
Name KATRIN REINHOLD
Position DIRECTOR GENERAL
Telephone number +372 7943900
Email address
[email protected]
The person applying for this certificate (Certificate Applicant)
Name KATRIN REINHOLD
Job title DIRECTOR GENERAL
Telephone number +372 7943900
Email address
[email protected]
The person who is authorised to verify the identity of the organisation
Name Katrin Reinhold
Address Uus-Tatari tn 25
15027
Invoice address
Name Tervise ja Heaolu Infosüsteemide Keskus
Address Uus-Tatari tn 25
EE-10134 Kesklinna linnaosa
Invoice reference:
[email protected]
Order information - Buypass SSL QWAC
Order number 1524265
Order date 29.04.2021
Payment Invoice
Ref: Registration and Application Form -70009770-23561215.pdf Side 1 av 2
REGISTRATION AND APPLICATION FORM
Domains and price
Certificate details
Buypass SSL QWAC - 1 year 378.95 EUR
valisrets.digilugu.ee
Total price 379.00 EUR
Certificate Information
Product Buypass SSL QWAC
Validity period 1 year
CSR common name valisrets.digilugu.ee
By my signature, I confirm that:
o All information in this form is correct
o The Subscriber's agreement for Buypass SSL certificates certifcates has been read and accepted
o The Organisation's Authorised Representative is authorised to verify the identity of the organisation.
____________________________________
____________________________________________________________________________
Place/date Signature (Contract Signer)
The completed form should be signed and posted or e-mailed to :
Buypass AS - Customer Service, Postboks 639, N-2810 Gjøvik, e-mail:
[email protected]
Guidance in completing the form can be reached on www.buypass.com
Buypass AS - Mailbox 4364 Nydalen N-0406 Oslo - Organisation no. 983163327 MVA Business enterprises
Ref: Registration and Application Form -70009770-23561215.pdf Side 2 av 2