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Subscriber information

Please enter the information as you would like it to appear on the certificate

The information collected on this page is subject to a treatment designed to receive information about our services, and to follow up and training of your application. Your personal information is exclusively intended for the persons authorized to process these requests. By clicking on "Next", I acknowledge having read the AGIS data protection policy having appointed a Data Protection Officer to the CNIL, by proving your identity, you can exercise your rights of access, rectification or deletion of information about you. You can also, for legitimate reasons, oppose the processing of your data. Please send us an email to dpo@agis-group.com.

Summary of your contract

src Subscriber information

src Edit

[civilite-payeur] [nom-payeur] [raisonSocial-payeur] [prenom-payeur] [numSiret-payeur]

[adresse-payeur], [code-payeur] [ville-payeur], [pays-payeur]
[indicatif-payeur] [telephone_fix-payeur]

src Beneficiary (s) of the contract

src Edit

[[personne--nom]] [[personne--prenom]]

[[personne--date-naiss]] - [[personne--nationalite]]
Passeport N° [[personne--passeport]]

for the whole period
[[personne--devis-pp]] €


Receive my quote by e-mail >

srcSelected formula
src Edit

srcDetails of your contract
Start date of the contract
src [provenance_pays]

End date of the contract
src [destination_pays]

Total amount
of the contract

[devis-st] €

Information documents