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VÝPOVĚĎ SMLOUVY O POSKYTOVÁNÍ TELEKOMUNIKAČNÍCH SLUŽEB

Tímto vypovídám smlouvu o poskytování telekomunikačních služeb.

Jméno a příjmení: .........................................................................................................................

Adresa trvalého bydliště: ..............................................................................................................

Adresa připojení: ..........................................................................................................................

Číslo OP: ......................................................................................................................................

Datum narození: ...........................................................................................................................

Autorizační kód: ............................................................................................................................

IP adresa: ......................................................................................................................................

Telefon/ mobil: .............................................................................................................................

E-mail: ..........................................................................................................................................

Důvod výpovědi: ..........................................................................................................................

Poznámka: ....................................................................................................................................

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Datum: ............................................... Podpis: ............................................................................

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