Xxxxxxxx xx 14.7.2005 xx 3.4.2007 (do xxxxxx č. 72/2007 Xx.)
Xxxxxxx č. 4 x xxxxxxxx x. 467/2003 Xx.
Xxxx tiskopisu xxx xxxxxxxx xxxxxxxxxx xxxxxxx
XXXXX
x xxxxxxxxx, xxxxxxx x vrácených xxxxxxxxxx xxxxxxxxx xx xxxxxxxx xxxxxxx
1. Xxxxx xxxxxxxxx xxxxxxxxxx xxxxxxx
x) xxx xxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxx xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx za xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: CELKEM:
____________________________________________________________________________________________
Datum převzetí Jméno x xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx úřadu:
b) xxx doutníky x xxxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx xxxxx:
x) xxx xxxxx
____________________________________________________________________________________________
Xxxxx balení Množství
(kg)
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx xxxxx:
2. Xxxxx xxxxx xxxxxxxxxx xxxxxxx xx výrobě xx xxxxxxx xxxxx České xxxxxxxxx
____________________________________________________________________________________________
Xxxxx vydání Obsah Xxxx pro Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx výroby užitých
cigaret
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet položek: XXXXXX:
____________________________________________________________________________________________
3. Výkaz xxxxx xxxxxxxxxx nálepek xxxx xxxxxx xxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx Xxxx pro Xxxxx xxxxxxxxxx nálepek v xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(ks, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx xxxxxxx poškozených
za xxxxxx xxxxxx xxxxx mimo xxxxxx xxxxx
xxxxxxx Xxxxx republiky České xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
4. Xxxxx xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxxx
____________________________________________________________________________________________
Xxxxx Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx v kusech
vrácení balení konečného __________________________________________
(xx, kg) spotřebitele vrácených celkem uznáno xxxxxxxx
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x xxxxxx
xxxxxxxxxx