Power of Attorney

I,
...................................................................................................
..... , the undersigned,

born
on................................................................................................
and

residing
at...........................................................................................


                                          hereby appoint


Mr /
Ms............................................................................................... ,
designated agent,

born
on................................................................................................
, and

residing
at........................................................................................... ,


as my agent (attorney-in-fact) to act for me in all legal and other matters linked and associated
with my enrolment as a student at the Faculty of Arts of Masaryk University in Brno, the Czech
Republic.

Signature: ..............................................................

Date: ......................................................................

Signed at: ..............................................................



I, the above designated agent, hereby acknowledge the receipt of this Power of Attorney


Signature: ..............................................................

Date: ......................................................................

Signed at: ..............................................................