L045

PROOF OF INCOME

Personal data of Employee (to be filled by Employee)

Employee:

First name, last name: Personal ID:

Permanent residence (street, number, city, postcode, country):

I request the issuance of the following proof of income for a loan request negotiated with Equa bank a.s. and in parallel give the following
Employer my consent to provide my personal data concerning my employment and my income, also on the phone. I acknowledge that
Equa bank a.s. is entitled to provide my Employer with the data on the requested loan in the scope which is necessary for a due
verification of information included in this confirmation.
I acknowledge that Equa bank a.s. shall process the provided personal data in the scope provided to Equa bank a.s. in connection to this
proof of income to negotiate about a contractual relation.

Place date: Clients signature:

Employer:
Name: Company ID number:
Seat (street, number, city, postcode, country):

Confirms that the aforementioned Employee is:

Employed as (role): Start of employment:

The average net monthly income of Employee has been CZK for the past 12 months: CZK in the past 3
months

If employment lasts for a shorter period of time than 12 months:

Average monthly net income CZK for the past: month(s):

The basic gross monthly salary of Employee as of the issuance day of this confirmation is: CZK

The following deductions are / are not made1 from the regular monthly salary:
Instalments for granted loans: CZK Deductions based on a court decision: CZK Other: CZK
At the same time we confirm that the Employee has:

A concluded employment contract:

permanent; fixed-term until ________________

Or agreement to complete a job; agreement to perform work

The Employee is in a trial period: Yes No. The Employee is in a notice period: Yes No
The Employee has been days on a sick leave over the past 12 months.

For the correct and complete data on behalf of Employer:

First name: Last name: Telephone:
Company name (if differing from Employer): Company ID number:
Seat (street, number, city, postcode, country):

This proof of income is valid for 30 days from the issuance day.

Place date: Signature and stamp of company:

1
Cross out if not applicable. Cross out unused items.