The undersigned request the rescission of the policy subscription
signed by the Service Municipal Water Binissalem's home indicated above, knowing that this Rescission
the payment policy will only be effective once the outage occurred or change of ownership of it, and having
all outstanding bills paid to date of cancellation.
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REASON FOR DEREGISTRATION
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Fm. (The applicant)
(Photocopy of ID as authorized signature)
Firmat (El titular)
(Adjuntar signed authorization holder) |
fm. (concesionari)
Antonio Gomila, S.A
Servei Municipal Aigües de Binissalem
A07405681
Olivar, 26 - POIMA 07714 Maó |