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Ame: Stra e: PLZ: Ort: Telefon: e-Mail: wichtige Hinweise Falls abweichende/r Kontoinhaber/in als der Halter weitere Angaben zum Fahrzeughalter Name: Geburtsdatum: Vorname: Geburtsort: Stra e: Beruf (bei Selbst ndigen): PLZ: Ort: Bankleitzahl: Bankleitzahl: Kontonummer: Kontonummer: Kontof hrendes Institut: Kontof hrendes Institut: Angaben zum Fahrzeug Fahrzeugart: Hersteller: Unterschrift abweichende/r Kontoinhaber/in Fahrzeug-Ident.-Nr.: Checkliste - reserviertes Wuns.

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