Application for Permit of Collective Visit/Excursion

to Liberty Ostrava a.s.

Applicant’s particulars
Name
Address
Contact person – name	Tel. no.	Fax no.	E-mail
Excursion
Place of excursion (plant)	Date	Time
Note
List of participants
Surname and first name	Date of birth	Signature *	Surname and first name	Date of birth	Signature *

* It shall be signed immediately before excursion commencement!

With my signature, I hereby acknowledge-edge that I will be acquainted with and I will adhere to the Rules for Persons Entering and Staying on the Premises of Liberty Ostrava and for the whole time of excursion duration, I will adhere to the instructions given to me by the Accompanying Officer.

I also acknowledge that Liberty Ostrava a.s., Company ID 451 93 258 (hereinafter the Controller), as the Controller and FENIX INTERNATIONAL, spol. s r.o. Company ID: 186 30 995 (hereinafter referred to as "the Processor") as the processor are authorized to process the data concerning me ("Data") that are required for the safe entry, transit, movement or proper performance of my activity in the premises of Liberty Ostrava ant to the registration of persons entering these Premises (hereinafter referred to as the "Purpose"). This processing is thus based on these legitimate interests of the Controller. The personal data can be transmitted to third person in the premises in whose interest the entry permit was granted. Processing will take place for the duration of the authorization and for subsequent 3 years. I further declare that I was acquainted with my right of access to the data, the right to rectification, the limitation of the processing, the addition or deletion, and the right to file a complaint with the Office for Personal Data Protection. I hereby confirm that the provided data concerning me are true.

Approval of the request by the manager of the dept., where excursion will be organized
Standpoint relating to the request	Stamp and signature
of the Approving Officer
Accompanying person – name	Tel. no.

Sent the request to the address of:	Liberty Ostrava a.s., Human Resources, Vratimovská 689/117, 719 00 Ostrava-Kunčice

or send it by e-mail to:	shall a school be the Applicant	Vera.Valkova@libertysteelgroup.com

in all other events	Miluse.Fukalova@libertysteelgroup.com