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SUBMIT YOUR PROPOSAL
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CONTACT INFORMATION
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SUBMIT A PROPOSAL
Viacstranovky formular EN
Consumer data
Information about the insurance company
Time data
Description of decisive facts
Other proceedings
Description of what the consumer is seeking in the proposal
Attachments
Consent
Summary
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How do you want to file a complaint?
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I submit the proposal anonymously
An anonymous proposal to start a consumer dispute will be rejected under Section 13, para. 1, letter (d) of Act No. 391/2015 Coll. on alternative resolution of consumer disputes, as amended.
Consumer data
Name and surname
*
Name and surname
Name
Name
Surname
Surname
Address of permanent residence:
Street and house number
Zip code
City
The address where I receive mail is different from my permanent residence.
Mailing address:
Street and house number
Zip code
City
Email address
*
Telephone no.
Email address
* mandatory information.
If you are human, leave this field blank.
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