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Mandaten-Fragebogen
Zur Bearbeitung der Handakte mache ich folgende Angaben:
Name: ............................................................................................
Vorname: ............................................................................................
Geburtsdatum/-name: ............................................................................................
Anschrift: ............................................................................................
............................................................................................
Telefon privat: ............................................................................................
Telefon tagsüber: ............................................................................................
Telefax: ............................................................................................
E-Mail: ............................................................................................
Rechtsschutzvers./Nr.: ............................................................................................
Selbstbeteiligung ja/nein ............................................................................................
Empfohlen durch: ............................................................................................
........................................... ...........................................
(Datum) (Unterschrift)
Prozessregister-Nr.: