Änderung persönlicher

Daten
Amendments of personal
data

Bitte Zutreffendes ausfüllen und unterzeichnet zurücksenden./

Please complete where applicable and return the signed form.

Vertragsnummer und/oder GVL ID

Contract No. and/or GVL ID: _____________________________________________________

Geburtsdatum/Date of birth: _____________________________________________________

Bisherige persönliche Daten/Previous personal data:

Name, Vorname:
Name, First Name: _________________________________________________________

Straße/Street: ______________________________________________________

PLZ, Ort/Post/ZIP Code, City: _____________________________________________________


Land/Country: _____________________________________________________

Telefon/Mobil/Telephone/Mobile: _____________________________________________________

E-Mail/E-mail: _____________________________________________________

Neue persönliche Daten / New personal data:

Name, Vorname:
Name, First Name: ________________________________________________________________

Pseudonym/Pseudonym: _____________________________________________________________

Neue amtliche Meldeadresse / New registered address:

Straße/Street: _________________________________________________________

PLZ, Ort/Post/ZIP Code, City: _____________________________________________________

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Land/Country: _____________________________________________________

Telefon/Mobil/Telephone/Mobile: _____________________________________________________

E-Mail/E-mail: _____________________________________________________

Ggf. von der Meldeadresse abweichende Korrespondenzadresse:

Alternative postal address if different:

Name/Name: _____________________________________________________

Straße/Street: _____________________________________________________

PLZ, Ort/Post/ZIP Code, City: _____________________________________________________

Land/Country: _____________________________________________________

Ggf. Postfachadresse:
P.O. Box if applicable:

Postfach/P.O.Box: ___________________________________________________________

PLZ, Ort/ZIP Code, City: ___________________________________________________________

Bitte nutzen Sie zur regelmäßigen schriftlichen Kommunikation mit mir:

For any correspondence with me, please use:

 Meldeadresse  abweichende Korrespondenzadresse  Postfach

Registered address Alternative address P.O. Box

Neue Bankverbindung / New Bank account:

Kontoinhaber/Account Holder: ________________________________________________

BIC/SWIFT/Bank Identifier Code: ________________________________________________


IBAN/International Bank Account Number: ________________________________________________

Name der Bank/Name of the Bank: ________________________________________________

Anschrift der Bank/Address of the Bank: ________________________________________________

________________________________________________

_________________________________________________

___________________________________ _________________________________________________
Ort, Datum/Place, Date Unterschrift/Signature

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