Piiriülese projekti portaali NCP uue sertifikaadi tellimus

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