S P L N O M O C N E N I E

Podpísaný/á ................................................................................................................................., nar. ................................., rodné číslo ......................................, č. OP ......................................., trvale bytom ................................................................................................................................, týmto splnomocňujem p. .............................................................................................................. nar. ................................., rodné číslo ......................................, č. OP ......................................., trvale bytom ................................................................................................................................, k (na) ............................................................................................................................................
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									vlastnoručný podpis

Podpis overil: .........................................
Dňa: .........................................