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User type:
I am an existing business partner
I am a policy holder
I am an authorised signatory for my company:
Yes, I am an authorised signatory for my company
Yes, but my company is bound to joint signature
No
Company name:
Language:
English
French
Dutch
German
Italian
Spanish
Please fill in your details.
Title:
Mr.
Miss
Mrs.
First name:
Last name:
Email address:
Mobile phone number:
No special characters allowed
eSignatureConsent
:
I have read and I understand the information on the
electronic signature process
adopted by Lombard International Assurance S.A.
Consent
:
I have read and I understand Lombard International Assurance S.A.’s
Privacy Notice.
GDPRConsent
:
By ticking this box, I
consent
to the use of my email address and mobile telephone number by Lombard International Assurance S.A. for the setup of my Connect account. I understand that the data collected are necessary to set up my electronic signature and to correspond with me via electronic means on matters related to my insurance policy. I acknowledge that I have had the opportunity to review the information given and ask any questions I might have had.