Warrant of attorney

Company:
 Identification Number   with residence in 
phone: 
fax: 
e-mail: 
bank account: 
 
in the following text as "client"
 
proxies
 

National Brokers Group a.s. , IN: 27423336, with residence in Praha 1, Nove Mesto, Vodickova 682/20, PSC 110 00
on record in bussiness index of City Court in Praha 5, division B, enclosure 10515
on record in the registry of insurance agents at MFCR, reg.number 038453PM

phone: 222 232 449
fax: 222 232 442
e-mail: info@nbgas.cz
Bank account: 35-6293970227/0100

( in the following text as "Broker" ),

to sit in for me, respectively to receive and give over all writtings, documents and records neccessary to enter insurance contracts, its changes, appendixes, rejections or possible operations leading to termination of these contracts with the right that the client has right to decide about the subject of insurance contracts as well as about the amount of insurance benefits.

This warrant of attorney I give to the broker as an extra warrant of attorney to all operations leading to liquidation of insurance events joined with above mentioned insurance contracts.

This warrant of attorney cannot be used to substitution at courts and and executive power.

Substitution of the client is according to this warrant of attorney free of charge.

According to this warrant of attorney client commits himself not to give another warrant of attorney to another insurance broker during the length of substitution based on this warrant. .

In date
Client:
 
I accept the warranty in its full range
 
On behalf for Nationals Brokers Group a.s.
Ing. Karel Stochl
the chairman of the board of directors