[%PROVIDER_TEXT%]
[%SUPPLY_POINT_EIC_1%]
[%SUPPLY_POINT_EIC_2%]
[%SUPPLY_POINT_EIC_3%]
[%SUPPLY_POINT_EIC_4%]
[%SUPPLY_POINT_EIC_5%]
[%SUPPLY_POINT_EIC_6%]
[%SUPPLY_POINT_EIC_7%]
[%SUPPLY_POINT_EIC_8%]
[%SUPPLY_POINT_EIC_9%]
[%SUPPLY_POINT_EIC_10%]
[%SUPPLY_POINT_EIC_11%]
[%SUPPLY_POINT_EIC_12%]
[%FULLNAME_OR_COMPANY%]
[%BIRTHDATE_OR_COMPANY_NUMBER_VAT%]
[%RESIDENCE_STREET%] [%RESIDENCE_NUMBER%] [%RESIDENCE_ZIP%] [%RESIDENCE_CITY%]