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Machtigingsformulier

Hierbij geef ik (betrokkene),

Naam: Nannan Panday

Voorletters: A.K.
Geboortedatum: 01-10-1964
ID-nummer: EI 004893M

Toestemming aan:

Naam: Nannan Panday

Voorletters: S.A.
Geboortedatum: 25-04-1997
ID-nummer: FP 001838V

hierna gemachtigde, om namens mij de automatische aftrek van de

maandelijkse kosten bij de SWM van het huis staande aan de New York
Straat 32,stop te zetten,waarna er maandelijks per kas betaald zal worden.

Plaats: Paramaribo,Suriname
Datum: 03-07-2018

Handtekening betrokkene:

Handtekening gemachtigde:

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