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Vardas pavardė Required Asmens kodas Required 🔒 Stored encrypted; only used to generate your draft. Deklaruotas adresas Required ⟦lt.field.accident_event_type⟧ Required — Accident at work Accident commuting Occupational disease ⟦lt.field.accident_date⟧ Required 📅 Format: DD/MM/YYYY ⟦lt.field.accident_time⟧ Required ⟦lt.field.accident_location⟧ Required ⟦lt.field.injury_type⟧ Required ⟦lt.field.accident_description⟧ Required ⟦lt.field.n1_act_number⟧ Required ⟦lt.help.n1_act⟧ ⟦lt.field.n1_act_date⟧ Required 📅 Format: DD/MM/YYYY ⟦lt.field.medical_institution⟧ Required Elektroninio nedarbingumo pažymėjimo numeris Required E-pažymėjimo numerį rasite ESPBI portale, savo el. sveikatos istorijoje arba klauskite šeimos gydytojo. ⟦lt.field.dlv_percent⟧ Optional ⟦lt.help.dlv_percent⟧ Darbdavio pavadinimas Required ⟦lt.field.employer_code⟧ Required ⟦lt.field.employer_address⟧ Required ⟦lt.field.job_title⟧ Required ⟦lt.field.insured_since⟧ Required 📅 Format: DD/MM/YYYY Šiuo metu dirbu Required — Yes No ⟦lt.field.witness_name⟧ Optional ⟦lt.field.witness_phone⟧ Optional Kontaktinis telefonas Required

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