LIFE CERTIFICATE

Croatian institute for pension insurance
Branch office Zagreb
Tvrtkova 5, 10 000 Zagreb

File number: .............................
Personal number: ..............................

LIFE CERTIFICATE

It is certified that .................., born on ................. in __________, with adress in ______________

is alive.

The information is approved based on the personal passport number ___________________ issued in _________________________ on day _______________________ and that is valid until ______________________________.


Place and date

_______________

Sign and seal of authorized person

____________________________

STATEMENT

I state with this document that I am not employed and I do not run an independent bussiness where I am insured.
(If you are employed and insured please attach the corresponding certificate of the employer)


Place and date

________________

Sign of the giver of the statement:

___________________________