TERMS AND CONDITIONS

TERMS AND CONDITIONS WWW.LATERANO.COM.PL

CONTENTS:

1. GENERAL PROVISIONS

1.1. The online store at www.laterano.com.pl is operated by POLANEX Sp. z o.o. with its registered office in Gniezno, ul. Słoneczna 40, 62-200 Gniezno, Poland entered into the register of entrepreneurs of the National Court Register by the Regional Court for Poznań-Nowe Miasto and Wilda in Poznań, 9th Commercial Division, National Court Register No. 00001383697, NIP [tax No.] 7840010501, REGON [statistical No.] 630144079, store address: contact@laterano.com.pl tel.: 0048 61 426 47 48

1.2. These Terms and Conditions apply to consumers and businesses that use the Online Store unless specified otherwise.

1.3. The Seller is the Controller of the personal data processed in the Online Store hereunder. The personal data are processed for the purposes, over the period, and based on principles indicated in the privacy policy available on the Online Store’s website at https://laterano.com.pl/polityka-prywatnosci/. The privacy policy contains mainly principles for processing personal data in the Online Store by the Controller, including bases, purposes, and period of personal data processing, rights of data subjects, and information regarding the use of cookies and analytical tools in the Online Store. The use of the Online Store and any purchase are done freely. Similarly, the Service User or Customer using the Online Store provide their personal data freely except for situations specified in the Privacy Policy (contract performance and statutory obligations of the Seller).

1.4. Definitions:

1.4.1. WORKING DAY – one day from Monday to Friday except statutory holidays.

1.4.2. REGISTRATION FORM – a form available in the Online Store for creating an Account.

1.4.3. ORDER FORM – an E-service, interactive form available in the Online Store for placing and Order, particularly by adding Products to an electronic bag and specifying Sale Contract conditions, including delivery and payment.

1.4.4. CUSTOMER, SERVICE USER – (1) a natural person with full legal capacity and, in cases provided by general provisions, also a natural person with limited legal capacity; (2) a legal person; or (3) an unincorporated organisational unit granted legal capacity by an Act of law that entered or intends to enter into a Sale Contract with the Seller.

1.4.5. CIVIL CODE – the Polish Civil Code Act of 23 April 1964 (Polish Journal of Laws of 1964 No. 16, item 93 as amended).

1.4.6. ACCOUNT – an E-service, set of resources in the ICT system of the Service Provider labelled by the Service User with an individual name (user name) and password where data provided by the Service User and information about their orders placed in the Online Store are kept.

1.4.7. NEWSLETTER – an E-service, electronic distribution service provided by the Service Provider via e-mail with which all Service Users that use this service can automatically receive regular consecutive editions of the newsletter from the Service Provider with information about Products, new articles and services, and special offers in the Online Store.

1.4.8. PRODUCT – a movable good available in the Online Store that is the subject matter of a Sale Contract between the Customer and the Seller.

1.4.9. TERMS AND CONDITIONS – the present Terms and Conditions of the Online Store.

1.4.10. ONLINE STORE – the online store of the Service Provider available at WWW.LATERANO.COM.PL

1.5. SELLER; SERVICE PROVIDER – POLANEX Sp. z o.o. with its registered office in Gniezno, ul. Słoneczna 40, 62-200 Gniezno, Poland entered into the register of entrepreneurs of the National Court Register by the Regional Court for Poznań-Nowe Miasto and Wilda in Poznań, 9th Commercial Division, National Court Register No. 00001383697, NIP [tax No.] 7840010501, REGON [statistical No.] 630144079, forwarding address: Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’, e-mail address: contact@laterano.com.pl tel. 0048 61 426 47 48

1.5.1. SALE CONTRACT – a sale contract for a Product entered into by the Customer and the Seller via the Online Store.

1.5.2. E-SERVICE – a service provided by electronic means by the Service Provider to the Service User via the Online Store.

1.5.3. CONSUMER RIGHTS ACT – the Polish Act of 30 May 2014 on consumer rights (Polish Journal of Laws of 2014, item 827 as amended)

1.5.4. ORDER – a Customer’s declaration of will made with the Order Form intended directly to enter into a Product Sale Contract with the Seller.

2. E-SERVICES IN AN ONLINE STORE

2.1. The Online Store offers the following E-services: Account, Order Form, and Newsletter.

2.1.1. Account. The Account can be used after the Service User completes all three consecutive steps: (1) filling in of the Registration Form, (2) clicking the ‘Create account’ field, and (3) confirming the intention to create an Account by clicking a confirmation link sent automatically to the specified e-mail address. The Service User needs to specify the following data in the Registration Form: first and last name / business name, address (street, house/unit number, postal code, place, country), e-mail address, contact telephone number, and password. Service Users who are not consumers need to provide the business name and tax identification number as well.

2.1.1.1. The Account E-service is provided free of charge for an indefinite period. The Service User may delete their Account (cancel it) any time for convenience by sending a relevant request to the Service Provider, particularly by e-mail to contact@laterano.com.pl or in writing to Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’

2.1.2. Order Form. The use of the Order Form starts upon the addition of the first Product to the electronic bag in the Online Store. An order is placed when the Customer completes both consecutive steps: (1) completion of the Order Form and (2) clicking the ‘Confirm purchase’button on the Online Store’s website having completed the Order Form. Now, they can modify the data entered (following the messages and information in the Online Store). The Customer needs to specify the following Customer data in the Order Form: first and last name / business name, address (street, house/unit number, postal code, place, country), e-mail address, contact telephone number, and data for the Sale Contract: Product(s), quantities of Product(s), place and method of delivery of the Product(s), payment method. Customers who are not consumers need to provide the business name and tax identification number as well.

2.1.2.1. The Order Form E-service is provided free of charge on a one-off basis and is concluded upon the placement of an Order with the Order Form or upon the discontinuation of Order placement with the Order Form by the Service User.

2.1.3. Newsletter. The use of the Newsletter starts after an e-mail address is entered on the ‘Newsletter’ page of the Online Store’s website to which consecutive editions of the Newsletter should be sent and the ‘Subscribe’field is clicked. The Service User may also subscribe to the Newsletter by selecting the relevant checkbox when creating their Account. In such a case, the Service User is subscribed to the Newsletter upon the creation of the Account.

2.1.3.1. The Newsletter E-service is provided free of charge for an indefinite period. The Service User may any time unsubscribe to the Newsletter (cancel it) for convenience by sending a relevant request to the Service Provider, particularly by e-mail to contact@laterano.com.pl or in writing to Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’

2.2. Technical requirements for the use of the ICT system used by the Service Provider: (1) a computer, laptop, or other multimedia-compatible device connected to the Internet; (2) access to e-mail; (3) up-to-date web browser: Mozilla Firefox; Internet Explorer; Opera; Google Chrome; Safari; Microsoft Edge; (4) the recommended minimum screen resolution: 1024×768; (5) cookies and JavaScript enabled in the browser

2.3. The Service User shall use the Online Store in compliance with legal regulations and principles of decency, respecting personal rights, copyrights, and intellectual property rights of the Service Provider and third parties. The Service User shall provide true data. The Service User may not provide illegal content.

2.4. Complaint procedure for E-services:

2.4.1. The Service User may file complaints related to the provision of E-services by the Service Provider and other complaints related to the operation of the Online Store (except for Product complaint, as specified in Section 6 hereof), for example,

2.4.1.1. in writing to Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’;

2.4.1.2.electronically via e-mail to: contact@laterano.com.pl

2.4.2. The Service User is advised to include in the complaint: (1) information and circumstances relevant to the subject matter of the complaint, particularly the type and date of the defect; (2) the Service user’s demands; and (3) contact data of the person filing the complaint to facilitate and streamline the Service Provider’s investigation into the complaint. The requirements specified in the previous sentence are guidelines only and do not affect the validity of complaints filed otherwise

2.4.3. The Service Provider responds to complaints immediately, not later than within 14 calendar days following a complaint.

3. SALE CONTRACT CONDITIONS

3.1. A Sale Contract is formed between the Customer and the Seller after the Customer places an Order with the Order Form in the Online Store as per Section 2.1.2 of the Terms and Conditions.

3.2. The Product price on the Online Store’s Website is expressed in PLN and includes VAT. The Customer is informed about the total price of the ordered Product, delivery cost (including transport, handling, and postal service fees), and other costs, or the obligation to pay them if any costs cannot be determined, on the Online Store’s website when placing an Order, including upon the declaration of will to be bound by a Sale Contract.

3.3. The procedure for entering into a Sale Contract in the Online Store with the Order Form

3.3.1. A Sale Contract is formed between the Customer and the Seller after the Customer places an Order in the Online Store as per Section 2.1.2 of the Terms and Conditions.

3.3.2. After order Placement, the Seller immediately confirms the receipt of the Order and accepts it for processing. The confirmation of Order placement and acceptance for processing is done by a relevant e-mail sent from the Seller to the Customer with at least a declaration by the Seller regarding the receipt of the Order and its acceptance for processing and a confirmation of the Sale Contract execution. The Sale Contract between the Customer and the Seller is formed when the Customer receives the e-mail specified above.

3.4. The content of such a concluded Sale Contract is preserved, secured, and provided to the Customer by (1) the provision of the Terms and Conditions on the Online Store’s website and (2) delivery to the Customer of the e-mail referred to in Section 3.3.2. of the Terms and Conditions. The content of the Sale Contract is additionally preserved and secured in the IT system of the Seller’s Online Store. 3.3.2. Regulaminu. Treść Umowy Sprzedaży jest dodatkowo utrwalona i zabezpieczona w systemie informatycznym Sklepu Internetowego Sprzedawcy.

4. PAYMENT METHODS AND TERMS

4.1. The Seller makes available the following payment methods under a Sale Contract:

4.1.1. Cash payment on delivery.

4.1.2. Cash payment on collection in person.

4.1.3. Bank transfer payment to the Seller’s bank account.

4.1.4. E-payments and card payment via PayU.pl and PayPal.com. The currently available payment methods are specified on the Online Store’s website on the page on payment methods at https://laterano.com.pl/obsluga-klienta/.

4.1.4.1. Rozliczenia transakcji płatnościami elektronicznymi i kartą płatniczą przeprowadzane są zgodnie z wyborem Klienta za pośrednictwem serwisu PayU.pl. E-payments and card payments are cleared as chosen by the Customer via PayU.pl. E-payments and cart payments are handled by

4.1.4.1.1. PayU.pl – PayU S.A. with its registered office in Poznań (office address: ul. Grunwaldzka 182, 60-166 Poznań, Poland), entered into the register of entrepreneurs of the National Court Register under the number 0000274399. The registration files are kept by the Regional Court Poznań-Nowe Miasto and Wilda in Poznań; share capital PLN 4,944,000.00 paid in full; NIP [tax No.]: 7792308495.

4.1.4.1.2. PayPal (Europe) S.à r.l. et Cie, S.C.A. , 22-24 Boulavard Royal, L-2449 Luxemburg, Trade register No. R.C.S. Luxembourg B 118 349

4.2. Payment deadline:

4.2.1. If the Customer chooses to pay by bank transfer, e-payment, or card, they shall make the payment within seven calendar days following the Sale Contract.

4.2.2. If the Customer chooses to pay cash on delivery or cash upon collecting Products in person, they shall make the payment upon receiving the delivery.

5. DELIVERY AND COLLECTION COSTS, METHODS, AND DATES

5.1. Product delivery covers the territory of Poland and the European Union.

5.2. Delivery fees apply unless otherwise stated in the Sale Contract. Delivery costs (including transport, handling, and postal service) are indicated to the Customer on the Online Store’s website, delivery cost page at https://laterano.com.pl/obsluga-klienta/ and when placing an Order, including upon the declaration of will to be bound by a Sale Contract.

5.3. The Seller makes available the following Product delivery and collection methods:

5.3.1. Post package, POD post package.

5.3.2. Courier package, POD courier package.

5.3.3. Delivery to a selected pickup point: lockers and PUDO

5.4. The lead time is up to 15 days excluding delivery unless the description of a specific product or information during Order placement specify a shorter period. In the case of multiple products with different lead times, the actual delivery date is the longest specified lead time, which must not exceed 15 days excluding delivery. The lead time is calculated as follows:

5.4.1. If the Customer chooses to pay by bank transfer, e-payment, or card the lead time starts on the day the bank account or clearing account of the Seller is credited.

5.4.2. If the Customer chooses cash payment on delivery, the lead time starts on the Sale Contract date.

6. PRODUCT COMPLAINTS

6.1. The basis and scope of the Seller’s liability towards the Customer in the case of a Product that is defective physically or legally (statutory guarantee) are specified by generally applicable regulations, particularly the Civil Code (including Articles 556–576 of the Civil Code).

6.2. The Seller shall provide the Customer with a Product free of defects.

6.3. The Customer may file a complaint

6.3.1. in writing to Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’;

6.3.2. electronically via e-mail to: contact@laterano.com.pl

6.4. The Customer is advised to include in the complaint: (1) information and circumstances relevant to the subject matter of the complaint, particularly the type and date of the defect; (2) the requested method for assuring compliance of the Product with the Sale Contract or a declaration to reduce the price or withdraw from the Sale Contract; and (3) contact data of the person filing the complaint to facilitate and streamline the Service Provider’s investigation into the complaint. The requirements specified in the previous sentence are guidelines only and do not affect the validity of complaints filed otherwise

6.5. The Seller responds to the complaint immediately, not later than within 14 calendar days following a complaint. If a Customer who is a consumer executes their rights under statutory guarantee and demands replacement of the object or removal of its defect or requested a price reduction by stating the amount by which the price should be reduced, and the Seller fails to respond to the request within 14 calendar days, the request is considered reasonable.

6.6. A Customer who exercises their statutory guarantee rights shall deliver the defective Product to Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’. If the Customer is a consumer, the delivery cost is covered by the Seller. If the delivery of a Product by the Customer is excessively difficult due to the type of the Product or its mounting method, the Customer is obliged to grant the Seller access to the Product in its location.

6.7. The Seller’s statutory guarantee liability does not apply towards a Customer who is not a consumer under Article 558(1) of the Civil Code.

7. OUT-OF-COURT COMPLAINT SETTLEMENT AND CLAIM SETTLING METHODS AND PRINCIPLES FOR ACCESSING THESE PROCEDURES

7.1. Details of how a Customer who is a consumer can use out-of-court complaint settlement and claim settling methods and principles for accessing these procedures are available in Polish on the website of the Polish Office of Competition and Consumer Protection at https://uokik.gov.pl/pozasadowe_rozwiazywanie_sporow_konsumenckich.php.

7.2. The President of the Office of Competition and Consumer Protection runs a contact point (tel. 0048 22 55 60 333, e-mail: kontakt.adr@uokik.gov.plor mail: Pl. Powstańców Warszawy 1, 00-030 Warszawa, Poland). One of its missions is to help consumer regarding out-of-court resolution of consumer disputes. Powstańców Warszawy 1, 00-030 Warszawa, Poland). One of its missions is to help consumer regarding out-of-court resolution of consumer disputes.

7.3. The options of out-of-court resolution of complaints and claims for consumers include: (1) a request to resolve a dispute to a consumer arbitration court (more at http://www.spsk.wiih.org.pl/); (2) a request to resolve a dispute out of court to the voivodeship Inspector of Trade Inspection (more at the website of an inspector locally competent for the seat of the Seller); and (3) aid of a district (city) consumer ombudsman or public organisation with a statutory obligation to protect consumers (including the Consumer Federation or Association of Polish Consumers). Consumers may seek advice via e-mail at porady@dlakonsumentow.pl and at 0048 801 440 220 (on Business Days 8:00 a.m. to 6:00 p.m., fees as per your plan).

7.4. The platform for on-line resolution of consumer-business disputes at the European level (ODR platform) is available at http://ec.europa.eu/consumers/odr. The ODR platform is an interactive and multilingual website with a comprehensive service point for consumers and businesses that seek out-of-court resolution of their dispute regarding contractual obligations under an online sales contract or service contract (more information on the platform’s website or on the website of the Office of Competition and Consumer Protection https://uokik.gov.pl/spory_konsumenckie_faq_platforma_odr.php – in Polish).

8. WITHDRAWAL RIGHT

8.1. A consumer who entered into a distance contract may withdraw from it within 14 days for convenience at no cost except for those in Section 8.8 of the Terms and Conditions. To comply with the time condition, the consumer has to send the statement within the time frame. A declaration of withdrawal may be made, for example,

8.1.1. in writing to Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’;

8.1.2.electronically via e-mail to:contact@laterano.com.pl

8.2. An example of a model withdrawal form can be found in Appendix No. 2 to the Consumer Rights Act and in Section 11 of the Terms and Conditions. The consumer may use the model form but it is not obligatory.

8.3. The withdrawal period commences

8.3.1. in the case of a contract whereby the Seller hands over a Product and is obliged to transfer the ownership (for example, a Sale Contract): from the moment the consumer or a third party indicated by the consumer – other than a carrier – takes possession of the Product. In the case of a contract (1) for multiple Products delivered separately, in batches or parts: from the moment possession is taken of the last Product, batch or part or (2) involves regular deliveries of Products for a definite period: from the moment the first such Product is taken into possession;

8.3.2. in the case of other contracts: from the contract date.

8.4. In the case of a withdrawal from a distance contract, it is considered not entered into.

8.5. The Seller shall refund all payments made by the consumer, including the Product delivery cost immediately, not later than within 14 days following the receipt of the consumer’s declaration of withdrawal (except additional costs of the delivery method selected by the consumer other than the cheapest regular delivery method available in the Online Store). The Seller shall make the refund using the same payment method as that used by the consumer unless the consumer explicitly approved a different method that does not entail any costs to the consumer. If the Seller did not offer the consumer a pickup of the Product, they may withhold the refund until they receive the Product or the consumer produces proof of dispatching the Product, whichever comes first.

8.6. The consumer shall return the Product to the Seller or a person authorised by the Seller to receive the Product immediately, not later than within 14 calendar days following the withdrawal unless the Seller offered to pick the Product up. To comply with the time condition, the consumer has to send the Product within the time frame. The consumer may return the product to Polanex Sp. z o.o., 62-200 Gniezno, ul. Słoneczna 40, Poland annotated ‘BOK laterano.com.pl’.

8.7. The consumer shall be liable for a reduced value of the Product as a result of use in excess of what is necessary to determine its nature, features, and functionality.

8.8. Potential costs of withdrawal the consumer shall cover:

8.8.1. If the consumer chose a delivery method other than the cheapest method available in the Online Store, the Seller may not refund the additional cost.

8.8.2. The consumer covers direct Product return cost.

8.8.3. In the case of a Product that is a service that was first rendered before the expiry of the consumer withdrawal period – upon an explicit request of the consumer– the consumer who withdraws shall, following a withdrawal statement, pay for services rendered before the withdrawal. The payment amount is calculated on a pro rata basis to the services rendered considering the price or remuneration specified in the contract. If the price or remuneration are excessive, the amount is calculated from the market value of the services rendered.

8.9. The right to withdraw from a distance contract under Article 38(3) of the Consumer Rights Act of 30 May 2014 (Polish Journal of Laws of 9 March 2017, item 683) does not apply to contracts for non-prefabricated Products manufactured according to consumer’s specifications (including dimensions or material type specified by the consumer) or intended to meet their individualised needs.

8.10. The consumer provisions in Section 8 hereof apply from 1 January 2021 and for contracts entered into from that day they apply also to a Service User or Customer who is a natural person concluding a contract directly related to their economic activity if, according to the content of the contract, the activity is not of professional nature for that person, particularly in terms of the scope of the economic activity provided based on the regulation on the Central Registration and Information on Business.

9. TERMS AND CONDITIONS FOR BUSINESSES

9.1. 9.1. This Section 9 and all its regulations apply to and bind only a Customer or Service User who is not a consumer, and from 1 January 2021 and for contracts entered into from that day, they apply to Customers and Users who are not a natural person concluding a contract directly related to their economic activity if, according to the content of the contract, the activity is not of professional nature for that person, particularly in terms of the scope of the economic activity provided based on the regulation on the Central Registration and Information on Business.

9.2. The Seller may withdraw from the Sale Contract within 14 days following its date. The cancellation of the Sale contract may be for convenience and is ground for no claims against the Seller.

9.3. The Seller may limit the available payment options and require partial or full advance payment regardless of the payment method chosen by the Customer and the fact of the Sale Contract formation.

9.4. The Service Provider may terminate the E-service contract effective immediately for convenience by notifying the Service User to this effect.

9.5. The liability of the Service Provider / Seller towards the Service User / Customer is limited to the amount of the price and delivery cost paid under the Sale Contract for a single claim and any claims in total regardless of its legal basis. Notwithstanding the above, the maximum liability amount is one thousand złotys. The amount limitation referred to in the two previous sentences applies to any claims of the Service User / Customer against the Service Provider / Seller, including if no Sale Contract is concluded or the claim is not relevant to a Sale Contract. The Service Provider / Seller shall be liable towards the Service User / Customer only for typical losses foreseeable on the contract date and shall not be liable for lost profits. The Seller shall not be liable for delayed transport of the shipment.

9.6. Any disputes between the Seller / Service Provider and the Customer / Service User shall be resolved by a court competent for the registered office of the Seller / Service Provider.

10. PERSONAL DATA PROTECTION

10.1. By accepting the Terms and Conditions, the Customer consents to have their personal data they provided processed by the Seller for the purposes of Sale Contracts the Customer is a party to and other services rendered by the Seller to the Customer. The processing of personal data is necessary for the performance of Contracts and the provision of services referred to in the previous sentence in accordance with regulations on personal data protection and the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation).

10.2.The personal data are processed for the purposes, to the extent, and based on principles indicated in the Privacy Policy available on the Online Store’s website at https://laterano.com.pl/en/terms-and-conditions/

11. FINAL PROVISIONS

11.1. Contracts entered into by the Online Store are in Polish only.

11.2. Amendments to the Terms and Conditions:

11.2.1. Usługodawca zastrzega sobie prawo do dokonywania zmian Regulaminu z ważnych przyczyn to jest: zmiany przepisów prawa; zmiany sposobów płatności i dostaw – w zakresie, w jakim te zmiany wpływają na realizację postanowień niniejszego Regulaminu.

11.2.2. In the case of continuous contracts entered into hereunder (such as the Account E-service), the amended Terms and Conditions are binding for the Service User if the requirements in Articles 384 and 384[1] of the Civil Code are satisfied, i.e. the Service User was properly notified about the changes and has not terminated the contract within 15 calendar days following the notification. Should a change in the Terms and Conditions introduce any new fees or raise the current fees, the Service User may withdraw.

11.2.3. In the case of non-continuous contracts entered into hereunder (such as a Sale Contract), amended Terms and Conditions do not infringe on acquired rights of Service Users / Customers before the day the amended Terms and Conditions enter into force. No amended Terms and Conditions will, in particular, affect Orders being placed or already placed or Sale Contracts that are being concluded, performed, or have been performed.

11.3. To all matters not settled herein, general provisions of the Polish law apply, in particular, the Civil Code, the Act on electronic services of 18 July 2002 (Polish Journal of Laws of 2002 No. 144, item 1204 as amended), the Consumer Rights Act, and other applicable regulations.

12. MODEL WITHDRAWAL FORM (APPENDIX NO. 2 TO THE CONSUMER RIGHTS ACT)

Model withdrawal form
(fill in and send the form only if you wish to withdraw from your contract)

– Addressee:

Polanex Sp. z o.o. „BOK laterano.com.pl”, 62-200 Gniezno, ul. Słoneczna 40, email: contact@laterano.com.pl

– I/We(*) hereby notify about the withdrawal from the sale contract for the following items(*) delivery contract for the following items(*) contract for specific work to produce the following items(*) / render the following services(*)

– Date of contract (*) / delivery(*)

– Full name of the consumer(s)

– Address of the consumer(s)

– Signature of the consumer(s) (only if sent by mail)

– Date

(*) Cross out as appropriate.