Registration form for the EKO-KOM system for companies established in other EU Member States – for concluding a contract with an Authorized Representative for Extended Producer Responsibility

Please fill in once your authorized representative is registered.

Data for the contract

VAT No.*

Company name*

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

The contract will be sent to the email address of the contact person listed below for qualified electronic signature. 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).

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

Correspondence address to the company

Same address as Registred office (place of business)

Street*

No.*

City*

Postal code*

State*

Phone*

E-mail*

Contact person

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

Name*

Surname*

Other data

Website

E-mail for receiving invoices*

IBAN

Comment

Authorized Representative for Extended Producer Responsibility

(voluntary – fill in only if you have)

Company ID*

Company Name*

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

First Name

Last Name

Phone

E-mail

Verification (CAPTCHA)

Click on the container standing correctly on the ground:*

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