P l n o m o c e n s t v o

Splnomocniteľ:

Podpísaný/á ............................................................................................
nar......................................, r. č. ....................................., 
bytom ......................................................................................................

splnomocňujem týmto 
................................................................................................................. 
nar. ........................., r. č. ............................,č.dokl.................................
bytom ......................................................................................................

na.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................

Toto plnomocenstvo platí .....................................

V ......................., dňa ...............

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Splnomocnenie prijímam v plnom rozsahu. 
								..........................................
V ................................., dňa ..................................