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REGISTRATION AND APPLICATION FORM Registration date: 06.05.2022 Organisation Information Organisation number 70009770 Organisation name Tervise ja Heaolu Infosüsteemide Keskus Address Pärnu mnt 132 EE-11317 Kesklinna linnaosa Telephone number +372 7943900 The person who will sign the contract (Contract Signer) Name MARGUS ARM Position DIRECTOR Telephone number +372 7943900 Email address [email protected] The person applying for this certificate (Certificate Applicant) Name JAAK VAABEL Job title SERVICE MANAGER Telephone number +372 7943843 Email address [email protected] The person who is authorised to verify the identity of the organisation Name Margus ARM Address Pärnu mnt 132 11317 Invoice address Name Tervise ja Heaolu Infosüsteemide Keskus Address Pärnu mnt 132 EE-11317 Kesklinna linnaosa Invoice reference: For QWAC certifikate valisrets.digilugu.ee Order information - Buypass SSL QWAC Order number 1578368 Order date 06.05.2022 Payment Invoice Ref: Registration and Application Form -70009770-24931789.pdf Side 1 av 2 REGISTRATION AND APPLICATION FORM Domains and price Certificate details Buypass SSL QWAC - 1 year 360.00 EUR valisrets.digilugu.ee Total price 360.00 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 -70009770-24931789.pdf Side 2 av 2