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Complaint submission form
Name and surname of the complainant Date of Birth Address Telephone E-mail
Complaint against
Subject of the complaint
What the complainant is requesting List of attachments submitted to clarify the case
Complaint completed by Date and time Signature of the complainant
Altoa s.r.o. | Medical Tourism Registration No.: 02620995 VAT ID: CZ02620995
client@altoamt.com altoamt.com +420 702 101 000
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Maiselova 38/15, 110 00 Prague 1 – Josefov, Czech Republic The Company Registered at Municipal Court in Prague, Czech Republic, le No. C 221494