certificate

of Income from Employment

Employer Information

Name
Identification No. (IČ)
Registered office (address)
Employee information

Surname
Name
Title
Birth number
Permanent address
Information on the employment of the employee – loan applicant

Current position
Employment commencement date
The employment is negotiated for:	indefinite time	definite period till ………………………………
Trial period in progress:	no	yes
Notice of termination given:	no	yes
Tax discount applied:	no	yes
Income paid:	cash	to the account
A job contract Full-time contract Agreement to comlate a job Agreement to perform work
Current base gross monthly pay
Average net monthly income, including the eventual sick leave benefits	in last three months,

i.e. from…………………………. till …………………………….
in last twelve months,

i.e. from ………………………… till …………………………….
Deductions are / are not taken off the income based on the execution of a decision/agreement on income deductions.
Purpose of deduction
Deduction amount
The Employer is aware that based on the employee’s consent Hypoteční banka, a.s. (hereinafter “the Bank”) is entitled to verify the correctness of the data provided in this Certificate of Income by phone. If the income in the last year was provided by multiple employers only the last employer shall fill in this Certificate.

The Certificate of Income was issued by: …………………………………………………	Contact telephone number: ……………….…

Name, surname, position

In ……………………………….….. on …..…………………………

…………………………………………………………

The Employer’s signature and stamp:

I confirm that all of the data entered is true. I also consent with the Employer giving the Bank information on my employment and amount of my income for the purposes of assessing my ability to repay a loan.

In case of foreigners without an assigned number please fill in the date of birth instead.

strana 2 / 2

Hypoteční banka, a.s., Radlická 333/150, 150 57 Praha 5, ID: 13584324

The company is registered in the Commercial Register held by the Municipal Court in Prague, Section B, Insert 3511

Client service information line: 224 116 333; www.hypotecnibanka.cz

potvrzení

Garant: odbor Řízení rizik
Platnost od: 25.07.2016

Kantor Martin

2017-09-01

zavodska

ČMHB