Insurance Data and Documents

Important! To insure two persons (principal borrower and co-borrower), each person need to fill in insurance application individually.

Insurance distribution notice

ERGO Life Insurance SE Latvian Branch (Reg. No. 40103336441, address: Skanstes Street 50, Riga, LV-1013; Phone: 1887 (or +371 67081887); E-mail: info@ergo.lv) The purpose of this application is to provide the Insurer with information that is necessary to conclude the insurance agreement. Filling in the application form does not bind the Policyholder or the Insurer to conclude the insurance agreement. If the insurance agreement is concluded, this application becomes its integral part. Do you agree that based on this this application Luminor will provide the Insurer with information that is necessary to conclude the insurance agreement?

You must agree with the Insurance distribution notice.

Connection with insured person

Do you plan to include two insured persons in the contract?
In order to insure two persons, it is necessary to fill in two insurance applications - each person submits his / her own application.

Association with a politically exposed person (PEP)

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Politically Exposed Person (PEP) a person who holds a top-level position in state or local government institutions in Latvia or in another country, or in an international organization, as well as a relative or closely related person of such a person. In the local law that regulates "Know Your Customer" requirements for financial institutions is described the precise PEP definition. Tap to close

Are you or your family member a politically exposed person or closely associated with a PEP?
Please open the form Know Your Customer - Private Individuals, fill it and upload below.
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Files must be less than 5 MB.
Allowed file types: pdf.Tap to close

Health risk appraisal requirements

What is your age?

Required documents: age up to 45 years, amount ≤ EUR 100,000

In order for ERGO to assess the insured risks, please provide answers to the following statements related to your health condition

Required documents: age up to 45 years, amount EUR 100,001 - 150,000

To continue the electronic application, please reduce the sum insured area or fill in the form  Extended Health Declaration and upload it in the field below.
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Files must be less than 5 MB.
Allowed file types: pdf.Tap to close

Required documents: age 46 to 59 years, amount ≤ EUR 60,000

In order for ERGO to assess the insured risks, please provide answers to the following statements related to your health condition

Required documents: age 46 to 59 years, amount EUR 60,001 – 120,000

To continue the electronic application, please reduce the sum insured area or fill in the form  Extended Health Declaration and upload it in the field below.
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Files must be less than 5 MB.
Allowed file types: pdf.Tap to close

Required documents: age 46 to 59 years, amount EUR 120,001 - 150,000

To continue the electronic application, please reduce the sum insured area or fill in the form  Extended Health Declaration and upload it in the field below.
ADDITIONAL REQUIREMENT: compulsory medical examination.
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Files must be less than 5 MB.
Allowed file types: pdf.Tap to close

Required documents: age 60 years or more, but less than 75 years at the end of the contract, amount ≤ EUR 40000

In order for ERGO to assess the insured risks, please provide answers to the following statements related to your health condition.

Required documents: age 60 years or more, but less than 75 years at the end of the contract, amount EUR 40,001 – 60,000

To continue the electronic application, please reduce the sum insured area or fill in the form Extended Health Declaration and upload it in the field below.
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Files must be less than 5 MB.
Allowed file types: pdf.Tap to close

Required documents: age 60 years or more, but less than 75 years at the end of the contract, amount EUR 60,001 – 150,000

To continue the electronic application, please reduce the sum insured area or fill in the form  Extended Health Declaration and upload it in the field below.
ADDITIONAL REQUIREMENT: compulsory medical examination.
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Files must be less than 5 MB.
Allowed file types: pdf.Tap to close

Health declaration – age up to 45 years:

1. I am healthy and able to work.
2. During the last five years I have not had any critical illness (except for colds and other acute illnesses), I have not had any injuries that have had permanent consequences for my health or physical condition, I have not had and do not plan to have right now any surgery or treatment in the hospital; I am not currently receiving treatment, medication or medical diagnostic tests
3. At work I am not exposed to an higher health risk or life risk (for example, dangerous work is work related with explosives, radioactive or toxic substances; work in the gas/oil industry; work in the armed forces, security service or aviation; work with a firearm; work at altitudes above 15 meters; work as a sailor, diver or firefighter). I am not a professional athlete whose sport is their main occupation or one of income sources
4. I do not do extreme sports or activities (for example, aviation, car racing or motor racing, martial arts, rugby, BMX / Downhill or similar cycling, roller skating on ramps, diving deeper than 30 meters, sailing, mountaineering, speleology, gliding or motorized/ non-motorized flying, kiteboarding, skydiving, bungee jumping, skiing in inappropriate places or using a parachute/ helicopter, horseback riding and similar sports or activities). I am not involved in professional or amateur sports (for the purposes of this insurance, engaging in professional or amateur sports means that it is your main occupation or one of income sources)
5. I have not had a definite disability or incapacity.

6. My body parameters

cm
kg

Health declaration - age 46 to 59 years:

1. I am healthy and able to work.
2. During the last five years I have not had any critical illness (except for colds and other acute illnesses), I have not had any injuries that have had permanent consequences for my health or physical condition, I have not had and do not plan to have right now any surgery or treatment in the hospital; I am not currently receiving treatment, medication or medical diagnostic tests
3. At work I am not exposed to an higher health risk or life risk (for example, dangerous work is work related with explosives, radioactive or toxic substances; work in the gas/oil industry; work in the armed forces, security service or aviation; work with a firearm; work at altitudes above 15 meters; work as a sailor, diver or firefighter). I am not a professional athlete whose sport is their main occupation or one of income sources
4. I do not do extreme sports or activities (for example, aviation, car racing or motor racing, martial arts, rugby, BMX / Downhill or similar cycling, roller skating on ramps, diving deeper than 30 meters, sailing, mountaineering, speleology, gliding or motorized/ non-motorized flying, kiteboarding, skydiving, bungee jumping, skiing in inappropriate places or using a parachute/ helicopter, horseback riding and similar sports or activities). I am not involved in professional or amateur sports (for the purposes of this insurance, engaging in professional or amateur sports means that it is your main occupation or one of income sources)
5. I have not had a definite disability or incapacity.

6. My body parameters

cm
kg

Health declaration - age 60 and over:

1. I am healthy and able to work.
2. During the last five years I have not had any critical illness (except for colds and other acute illnesses), I have not had any injuries that have had permanent consequences for my health or physical condition, I have not had and do not plan to have right now any surgery or treatment in the hospital; I am not currently receiving treatment, medication or medical diagnostic tests
3. At work I am not exposed to an higher health risk or life risk (for example, dangerous work is work related with explosives, radioactive or toxic substances; work in the gas/oil industry; work in the armed forces, security service or aviation; work with a firearm; work at altitudes above 15 meters; work as a sailor, diver or firefighter). I am not a professional athlete whose sport is their main occupation or one of income sources
4. I do not do extreme sports or activities (for example, aviation, car racing or motor racing, martial arts, rugby, BMX / Downhill or similar cycling, roller skating on ramps, diving deeper than 30 meters, sailing, mountaineering, speleology, gliding or motorized/ non-motorized flying, kiteboarding, skydiving, bungee jumping, skiing in inappropriate places or using a parachute/ helicopter, horseback riding and similar sports or activities). I am not involved in professional or amateur sports (for the purposes of this insurance, engaging in professional or amateur sports means that it is your main occupation or one of income sources)
5. I have not had a definite disability or incapacity.

6. My body parameters

cm
kg

Required documents

To continue the electronic application, please reduce the sum insured area or fill in the form  Extended Health Declaration and upload it in the field below.
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Files must be less than 5 MB.
Allowed file types: pdf.Tap to close

Insurance amount

EUR
EUR
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Total and permanent disability insurance is always offered together with life insurance, and insurance benefit will be paid out for severe disability (I group) that has been suffered as a result of an accident, has caused permanent loss of capacity for work and persists without interruption for at least 12 months, for example, sudden loss of eyesight after an car accident. Disability group is determined by The State Medical Commission for the Assessment of Health Condition and Working Ability.Tap to close