Questionnaire for Slovak republic location codes TMC tables applicant (Country code: 5, Location table number: 51, Version: 5.0, Table type: Public) 
(hereinafter referred to as „LC tables“)

Distributor: 
Company: Slovenská správa ciest (Slovak Road Administration)
Contact address: Dúbravská cesta 1152/3, 841 04 Bratislava, Slovak republic	
Contact person: 
Name: Alica Szebényiová 
Tel: +421 2 50255 388, +421 903 284 340
	E-mail: alica.szebenyiova@ssc.sk

Applicant: 
1. Name of the company: 
2. Residence of the company:
3. Contact address: 
4. Contact person:
	Name: 
	Tel:
	Fax:
	E-mail: 

5. Type of organization: State/public institution (  )	           Private company (  ) 

6. Operation/business area of applicant:
(  ) Producer of in car built navigation systems 
(  ) Producer of portable navigation systems
(  ) Producer of navigation databases
(  ) Service provider in the area of traffic information via RDS/TMC
(  ) Other - specify: 

7. How do you want to use the Slovak LC tables? (describe briefly)   

8. Do you expect to use the Slovak LC tables for applications, products or services based on RDS/TMC?
(  ) Yes
(  ) No/other distribution channels (specify):  

All the information in this questionnaire are treated as confidential. Distributor reserves the right to consult given information among parties, which are its cooperators in the area of processing, updating and certification of the Slovak LC tables.   

Please, send the filled questionnaire to the contact person of the distributor. 

In …………………………………..  Date ………………………………..

Signature of the applicant contact person: