Insurance of student's personal belongings at Masaryk University students dormitory

Insurance of student's personal belongings at Masaryk University students dormitory - Questionnaire Customer Details  Degree before name    First name    Surname    Degree behind name    ID Number    Passport number    Living at  Street, Street No.    Town    ZIP Code    Country    Contact  Telephone No.    e-mail    Place of Insurance  Room No.    Address of accommodation facility    - select - Bratislavská 234/52, 60200 Brnobří Žůrků 45, 61700 BrnoCikháj 45, 59102 Žďár nad SázavouČejkova 21, 61500 BrnoGrohova 11, 60200 BrnoKlácelova 2, 60200 BrnoKounicova 50, 60200 BrnoLomená 48, 61700 BrnoMánesova 12c, 61200 BrnoNádražní 58, 66451 ŠlapaniceNáměstí Míru 4, 60200 BrnoSladkého 13, 61700 BrnoTvrdého 5/7, 60200 BrnoVeveří 29, 60200 BrnoVinařská 5, 60300 BrnoŽerotínovo nám. 9, 60177 Brno- Other address - Other address    Accomodation contract      upload scanned Accomodation contract Beginning of insurance coverage    (d.m.yyyy) End of insurance coverage    - select - 31.03.202630.4.202631.5.202630.6.202631.7.202631.8.2026 Sum insured    - select - 100 000 K�150 000 K� Insurance    Insert the beginning and the end of insurance coverage and select the sum insured Notes    By submitting his\her first name and surname the insured person agrees that he\she:  was aware and agrees with the following terms and conditions of the Insurance contract. Pojistn� smlouva �. 400 022 138.pdf     M420.pdf     M401-SU-02_2007.pdf     Dodatek �.6.pdf was informed that each insured incident of theft or burglary must be reported to the Police of Czech Republic. must report the insured incident through e-mail: [email protected] or by calling: +420 844 144 144. Insurance is valid only from the date the payment has been received to e-Finance a.s. bank account. Payment must be made through on-line PayMUZO service or by account to account transfer to e-Finance a.s. bank account. First name of the insured person    Surname of the insured person    Payment methods       VISA, Mastercard, Maestro - PayMUZO System (3D Secure)    Transfer to CSOB account    Transfer to Ceska Sporitelna, a.s. account    Transfer to Komercn� banka, a.s. account    Transfer to different bank account

By submitting the form, I consent to place my personal data in information database of e-Finance a.s. company. I agree with the processing of personal data in accordance with the law c. 101/2000 Sb. - personal data protection. I am aware of the fact that my personal data will not be accesed by third parties without my consent. I confirm that I am aware of the fact that I have the right to view my personal data, correct them and and eventually delete them from the database.