HOUSE_OVERSIGHT_073446

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ESPUBLIKA / REPUBLIC OF LITHUANIA / REPUBLIQUE DE LITUANIE Be _ 2s Valstybés kodas / Paco:Nr, / Passp.st No. / N' du passeport ~s Code of state mo ef Type Code du pays 1, Pavardé / Surname / Nom 2. Vardai / Given names / Prénoms 3. Piletybé / Nationality / Natlonalité LIETUVOS RESPUBLIKGS 4, Gimimo data / Date of birth / Date de naissance MOT/F iki / Date of expiry / Date d’expiration ee a aM 6. tytis / Sex/ Sexe os ee 7. ii Pace seo 8, Edavimo data / Date of issue / Date de délivrance —_ rarer Holder's signature / Signature du titulaire Yr HOUSE_OVERSIGHT_073446

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