Benefits for Persons with Disabilities - KoP Jilemnice - Order

Services available here:

Mobility Allowance
Special Aid Allowance
Disability Card

Kontaktní pracoviště Jilemnice, Masarykovo náměstí 8, 51401 Jilemnice

Personal data

Surname

Please fill in the surname.

Middle name (optional)

Name

Please fill in your first name.

Email address

Please fill in the Email address.

Phone

Please fill in your phone number.

Date of visit, time of day

free

selected

I agree to the processing of data for the purpose of processing the ordered service.

Please confirm your consent before sending.

What's the date today, day?

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Note/Clarification (optional)

After sending the completed form, expect an information letter in your e-mail box with instructions on how to process the ordered service. Please read them carefully.