Fillable MachtigingsformulierVOG BRP BS

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MachtigingsformulierVOG BRP BS

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Country of origin: OTHERS
File type: PDF

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Koningsplein 3 | 5721 GJ Asten | Postbus 290 | 5720 AG Asten
T (0493) 671 212 | F (0493) 671 213 | www.asten.nl | gemeente@asten.nl
IBAN Rekeningnummer: NL16 BNGH 028.50.00.519 | BIC-code BNG: BNGHNL2G
Machtigingsformulier
Hierbij machtig ik:
Voornaam
Achternaam
Geboortedatum
Geboorteplaats
Adres
Postcode
De hieronder vermelde persoon:
Voornaam
Achternaam
Geboortedatum
Geboorteplaats
Adres
Postcode
Woonplaats
Tot het aanvragen van:
Omdat het nodig is voor:
Datum:
Handtekening machtiginggever:
LET OP! Kopie legitimatiebewijs van de machtiginggever meenemen en een geldig legitimatiebewijs
van de gemachtigde.
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MachtigingsformulierVOG BRP BS

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Completed 21 April 2021

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