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Complaint submission form

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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

fi

Maiselova 38/15, 110 00 Prague 1 – Josefov, Czech Republic The Company Registered at Municipal Court in Prague, Czech Republic, le No. C 221494


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Complaint submission form by ALTOA - Issuu