Registration Form for the EKO-KOM System

Data for the contract

Company ID

VAT No.*

Company name*

If your company doesn't have a registered seat in The Czech Republic, please fill in a VAT Affirmation for EU or non-EU clients and attach it below.
(If it does, please contact us here for next instruction: info@ekokom.cz, +420 729 848 444)

Affirmation about VAT (doc, docx, pdf)

Registered office (place of business)

Street*

No.*

City*

Postal code*

State*

Represented by (Statutory Representative)

(person who signs the contract)

Name*

Surname*

Name

Surname

Name

Surname

Name

Surname

Name

Surname

Please attach a document proving the authority is authorised to act on behalf of the company and sign the contract (for example a copy of an extract form the business register). In case your company will be represented by another company / person, please attach a Power of Attorney.

Document proving the authority is authorised
(to act in behalf of the company and sign the contract) or Power of Attorney

Czech data box identifier

Contact person

(person who fills in quarterly statements and communicates with EKO-KOM, a.s.)

Name*

Surname*

Correspondence address

Same address as Registred office (place of business)

Street*

No.*

City*

Postal code*

State*

Phone*

E-mail*

Other data

Website

E-mail for receiving invoices

IBAN

Choose the predominant business activity

Producer / Importer of packaged goods

Distributor of packaged goods

Retail business - seller to consumer (in predominant extent)

Producer / Importer of packaging means

Comment

Verification (CAPTCHA)

Click on correctly rotated container:*

I agree to the processing of personal data for the needs of EKO-KOM, a.s. *