Letter of Consent

I, ………………………………….., born on……………….., nationality: ……………………… hereby authorise the broker agent

Kiwi.com s.r.o., company ID No.: 29352886, with registered offices at Palachovo náměstí 797/4, Starý Lískovec,

Post Code 625 00 Brno, Czech Republic, registered in the Commercial Register maintained by the Regional

Court in Brno, file no. C 74565, Tax ID No. CZ29352886 and its authorised ticketing partners undertaking

the below mentioned booking, to apply for and obtain on my behalf any available refund stemming from

the contract of carriage concluded between myself and the carrier ………………… under this Passenger Name

Record: ………………………………………………………… and under this number of the e-

ticket……………………………………………………………………………………………………………………………………………………………………….

For the performance of this refund request is necessary to provide a copy of the passenger passport that I am

attaching to this letter.

Sincerely,

In …………..on ……………….. ……………………………………….