Registration Form for the EKO-KOM System

Data for the contract

Company ID

VAT No.

Company name*

If you do not have a Czech VAT No., please fill in a VAT Affirmation for EU clients or non-EU clients.

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

In case your company will be represented by another company, please fill in Power of Attorney.

Power of Attorney (doc, docx, pdf)

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

Mark the predominant business activity with a cross

Producer / Importer of packaged goods

Distributor of packaged goods

Retail business - seller to consumer (in predominant extent)

Producer / Importer of packaging means

Comment

Select the correctly rotated container*

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