Statutory city of Brno - Department of Transport Brno City Hall 
separation of public and private transport 
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Kounicova 67, 601 67 Brno, identification number 44992785, tel.542171111, fax 542174013, handles line 4205 
e-mail: od@brno.cz or mundova.astrid@brno.cz, 
office hours Mon, Wed 8.00 to 17.00 hrs., and Fri from 8.00 to 12.00 hrs. 

The application form for a permit entry 
according to § 77 of the Act č.361 / 2000 Coll., Article 29 of the Statute of the City of Brno and § 10, 15 of c.565 / 1990 Coll. 
odd.VII a decree of Brno no. 22/2010, all as amended 

1 / applicant (first name, last name, full address, date of birth / organization - business name, address, identification number, stamp, contact address: 

2 / u organizations responsible employee (phone, working contact address): 

3 / desired point of entry and reason for the request: 
     (Annex needed: in the case of registered office / establishment of the company = copy of the lease contract for the use of residential premises for business - details of the Contracting Parties, the specification of the space, the lease term, the possibility of hiring third party, date and signatures (not older than 2 years, Otherwise, the same + certificate owner / property manager about the next term of the lease), registration of establishments ŽÚ; property owner - LV, building construction activity = authorization / notification works / economic contract work in progress + ZUK; doctors -RENT contract decision MMB / diploma, specialty lawyers = lease agreement, registration CBA; supply = list of customers) 

4 / desired number of passes: 
   (How many cards require authorization, license plate / RZ, vehicle type, copy TP - in total cargo weight and axle load when the vehicle is higher than the total weight of 6.5 tons - BKOM as necessary agreement, the second a vehicle for corporate passes is required OTP / ORV = vehicle registration certificate or. statement of compliance with the highest emission limits) 

5 / desired date of entry: 
   (day - month - year, or time) 

6 / In accordance with Law no. 101/2000 Sb., As amended, hereby grant the Department of Transport MMB indefinitely its consent to the electronic or other processing of personal information in the application for the purpose of issuing the entrance to the central area of ​​the city of Brno. As an individual, I agree to the processing of their personal data to process the application in accordance with law no. 133/2000 Sb., As amended, for registration of population and birth numbers. 
I agree with making copies of personal and corporate documents for these purposes. 
If it is not at any point have enough space for your message, attach a new sheet. 
7 / We declare that all particulars supplied by me in this application is true. 

8 / Brno, ........................................ signature .... .................................................. . ........................... .... 

  Local tax according to valid regulations of SMB ......................... .......................................... .CZK

Enabling serial number / registration number of assumed name and signature:					

Notes: The power of attorney for representation, processing and acquisition (original or certified copy) 
Required documents - see above. 

Notes: 
VOR - an extract from the Commercial Register, Freelance - trade license, TLO - Trade Office, OP - identity card, CBA - Czech Bar Association, TP - vehicle registration, OTP - certificate of roadworthiness = ORV - vehicle registration certificate (popularly small technical certificate) ZUK - the decision to use a particular communication, license plate - license plate, RZ - registration number, total weight / maximum technically permissible / allowable weight = figure listed in TP / ORV vehicles - item F1 / F2, LV - list property for real estate 

CAUTION: Incomplete applications and applications without documents will not be 
account! 

The data verified by: 

Postal Order / certificate for payment issued on: ................................ ........................... .................. ... 

Local tax according to valid regulations of SMB .................................... .. CZK 

paid on ............ ........................... at checkout ODMMB - money order - bank transfer to account number MMB 7510006631/5400, variable symbol 541346, a specific symbol is the reference number

Poučení:  Potvrzuji převzetí požadovaného povolení vjezdu a  informačních materiálů, zároveň beru na vědomí, že jsem povinen respektovat aktuální dopravní značení .

Vyřízeno, převzal dne, podpis :  

Formulare – 13 -zadost_vjezdy firmy - 13-04-10