Upoważnienie na transport zwłok w j.angielskim

,,GLOB’’ S.C. Jarosław Drejka, Maciej Drejka
Polska 06-200 Maków Maz. ul. Liliowa 11
tel. 00-48-604-354-119
fax (0048-29) 71-71-827
e-mail: [email protected]
………………………………….2014
Place and date:
Authorization
I
……………………………………
authorize
GLOB
S.C.
J.Drejka,
M.Drejka address Liliowa 11, 06-200 Maków Maz., Poland to arrange
and
conduct
the
Repatriation
of
the
body
Mr./Ms
GLOB
S.C.
J.Drejka,
…………………………………… to Poland.
I
……………………………………
authorize
M.Drejka address Liliowa 11, 06-200 Maków Maz., Poland to sign any
documents on my behalf.
Signed
……………………………………,
Date
…………….2014
Relationship to Deceased – ……………………………………
Address
……………………………………,
……………………………………
…………………………………
(signature)