. "jm\u00E9no, p\u0159\u00EDjmen\u00ED, rodn\u00E9 \u010D\u00EDslo a adresu m\u00EDsta trval\u00E9ho pobytu zvl\u00E1\u0161tn\u00EDho p\u0159\u00EDjemce," . . "122/3/v" . "v" . . "m\u011Bs\u00ED\u010Dn\u00ED v\u00FD\u0161i zaplacen\u00E9ho pojistn\u00E9ho na poji\u0161t\u011Bn\u00ED, jde-li o zahrani\u010Dn\u00EDho zam\u011Bstnance," . .