Terms and Conditions
General Terms and Conditions
1.These General Terms and Conditions (hereinafter referred to as the "Terms and Conditions") shall apply to purchase in the e-shop www.dedoles.nl, operated by Dedoles s.r.o, having its registered office at Za Koníčkom 14, 90201 Pezinok, Slovakia, Company ID (ICO): 46706305, registered with the District Court Bratislava I, Insert No.: 81976/B, email: email@example.com, contact person: Jaroslav Chrapko, telephone number: +421 0917 611 041.
- Terms and Conditions form an integral part of the concluded purchase contract between the buyer, on one hand, and the seller, on the other hand.
- All contractual relations are concluded in accordance with the valid legislation of the Slovak Republic.
- In the case the consumer is a contracting party, the contractual relations, not regulated by these Terms and Conditions, shall be governed by the Act:
- N 40/1964 Coll., Civil Code as amended,
- N 250/2007 Coll. on Consumer Protection as amended,
- N 102/2014 Coll. on Consumer Protection during the sale of goods or provision of services on the basis of the distance contract or contract concluded outside the operating premises of the seller and on amendment and supplement to certain acts as amended,
- N 22/2004 Coll. on E-Commerce and on amendment and supplement to the Act No. 128/2002 Coll. on State Control of the Internal Market in Consumer Protection Matters and on amendment and supplement to certain acts as amended by the Act No. 284/2002 Coll. as amended.
- In case the entrepreneur is a contracting party, the contractual relations not regulated by these Terms and Conditions shall be governed by the Act No. 513/1991 Coll., Commercial Code as amended.
Definition of Terms
- A Consumer Contract shall mean any contract, irrespective of its legal form, which is concluded between the supplier and the consumer.
- A Seller shall mean the company Dedoles s.r.o., which operates e-shop. Its subject matter is the sale of goods through e-shop and is located on the website dedoles.nl (hereinafter referred to as the “e-shop”).
- A Buyer shall mean the customer, which on the basis of the purchase contract enters into a contractual relationship with the seller.
- A Customer of our e-shop shall mean any natural person authorized to legal acts or legal person that has expressed an interest in purchasing goods in the e-shop. The customer under these Terms and Conditions shall also mean, in certain circumstances, a third party which the customer designates in the binding order as the person to whom the ordered goods are to be handed over (hereinafter referred to as the "Authorized Person"). Indication of the name of the Authorized Person in the binding order shall be deemed its authorization to take the ordered goods over.
Order and Conclusion of Purchase Contract
- The Buyer chooses a product based on the actual offer published on the e-shop, confirms its selection by clicking on the button “Buy”, fills in the order form (e-mail, in case of product purchase also the delivery address), chooses the quantity of products (eventually specify the products parameters) and chooses the method of payment (cash on delivery, cash on personal receipt).
The orders placed through the e-shop are binding. When placing the order, the Buyer confirms, by active clicking that it acquainted itself and agreed with these Terms and Conditions.
- 2. The placement of offered products in e-shopconstitutes the motion to conclude a contract, contract is concluded by sending the order by the Buyer and by the acceptance of this order by the Seller. After processing your order the Seller shall send without undue delay the confirmation of the receipt of the order (acceptance of the order) to the e-mail address entered by the Buyer, this confirmation contains order number, name and specification of the goods, information on price of the goods and costs of delivery (postage), method payment, information on the estimated delivery time of the goods, information on the place where the goods are to be delivered, information on the Seller or other information. By receiving a confirmation e-mail on receipt of your order, purchase contract is concluded.
- In case you have an account created with us, your order will also be archived in My Orders section, which will only be accessible to you after login. If necessary, any additional information regarding the order may be sent to the Buyer's email address.
- The Contracting Parties agreed that the communication between them will be executed in the form of e-mails.
- The Buyer is obliged to pay the Seller the price of goods agreed in the order confirmation including costs for delivery of goods (hereinafter referred to as the “Purchase Price”) by means of cash on delivery in the place of delivery of the goods or by wire transfer to the Seller´s account specified in the order confirmation.
- The Buyer is obliged to pay the Seller the Purchase Price for the agreed goods within the period stated in the order confirmation at the latest when the goods are taken over.
- Information regarding the particular steps leading to the conclusion of contract emerge from these Terms and Conditions. The Buyer shall always have the possibility to check or eventually correct the contract before sending the order. The contract is concluded in the Slovak language, if no circumstances obstructing the conclusion of contract exist on side of the Seller and the Buyer, it is possible to conclude the contract in different, for both parties comprehensible, language.
- The operator shall deliver to the Buyer, included with the goods, all proper documents related to goods: invoice (tax document), eventually also warranty certificate (if provided by the producer).
- The buyer can cancel the order by e-mail or telephone if it has not yet been processed. To cancel your order, contact us via the contact form.
- All prices of goods and services are set as final, including the corresponding VAT in the amount set by valid legislation of the Slovak Republic (usually 20% - the exact rate can always be found on the invoice), however, it does not include the price of delivery of goods.
- All special offers are valid until stocks are sold out, unless otherwise specified for a particular product.
- Any additional discounts that are provided in addition to the product-specific discounts on our website, individual customer discounts or discounts provided on the basis of our e-shop’s cooperation with third parties are not mutually combinable.
- Final price is stated in the order form right before sending the order, it includes VAT, eventually all other taxes and fees (packaging, postage, etc…), which the Consumer must pay in order to obtain the product or service. It is not possible to unilaterally change this price by the Seller.
- The goods which are available in stock are dispatched the next business day.
- The goods which are not available in stock are always marked as “Currently unavailable”.
- Unless the Seller and the Buyer have agreed otherwise in the purchase contract, we, as the Seller, are obliged to fulfil your order and deliver the goods no later than 30 days from the receipt of the order. If the ordered goods or part of the goods from the order cannot be delivered within the above-mentioned time limit, we will inform you about this situation as soon as possible and notify you of the expected date of delivery of the goods or we suggest delivery of replacement goods. If we are unable to arrange the goods within an additional period, you have the right to withdraw from the contract and in the case of payment of the Purchase Price or part of it, you will be refunded within 14 days to your designated bank account.
- We process orders every business day.
Place and Method of Delivery
- The obligation to deliver the goods is fulfilled by handing over the goods to the Customer or to the Authorized Person specified in the order. Goods are sent by the Slovak Post in the form of a letter/package or letter/package cash on delivery, or by courier for a surcharge. Therefore, it is necessary to add 1-3 business days to the delivery period, which takes the delivery of the product to you by the Slovak Post, or 1 working day for delivery by courier service.
- You can pick up the goods in the mail order - personal takeover.
- We will notify you by e-mail that your order has been submitted to the carrier. If the goods have not been delivered to you within 7 days after our e-mail, please contact your delivery post office and us. We will then provide you with more information about your package and possible reasons for non-delivery via e-mail. If you have a user account, you can check the current status of processing of your order at any time in My Orders.
- The Customer is obliged to take the goods over in person at the agreed place and time or arrange its The Customer confirms receipt of the goods in writing in the delivery note, which is also a proof of payment of the goods in the case of cash on delivery. Together with the goods the Customer receives an invoice, which also serves as a warranty certificate.
- The obligation to deliver the goods shall be considered fulfilled even if the Customer does not take the goods over at the agreed time and at the agreed place or refuses to take the goods over. In the event that the Customer does not take the goods over and the goods are returned to us, we have the right to withdraw from the purchase contract and to claim from the Customer the costs related to return of the goods (the Seller has a right to damage compensation according to § 420 et. seq. of the Civil Code) in the amount of the actual costs related to attempt to unsuccessfully order delivery - postage related to the return of the goods). Re-delivery of the shipment is possible only after mutual agreement. The Seller is also entitled not to exercise the right to damage compensation or to exercise this right only in part.
- We are not responsible for delayed delivery of goods caused by incorrectly stated address of the recipient. The Customer acquires the ownership right to the goods by taking them over at the place of delivery. By taking the goods over, the risk of accidental destruction and accidental deterioration also passes to the C
- Upon receipt of the shipment, the Customer is entitled to check the shipment for any damage to the package (mechanical damage caused by transport) and whether the goods are free from defects. In case of visible damage to the shipment or goods, the Customer is entitled not to take the shipment over. In the event that the shipment is damaged, the Buyer does not take the goods over and writes the protocol with the delivery company.
Payment Method, Postage and Other fees
- The Buyer shall pay the Purchase Price to the Seller by:
- Credit card
- Bank Wire Transfer to the account:
- Complete information about payment options can be found here.
- The Buyer may use a discount coupon, when applying it the Buyer will be provided with the relevant discount.
- The following postage fees are added to the prices of goods according to the method and address of delivery. Complete shipping conditions can be found here.
- We do not charge any other packing fees.
- Discount code:
- can only be used once;
- cannot be exchanged for cash;
- The value of the discount code is stated with VAT.
- The gift voucher can be used once for the purchase of goods in the online store www.dedoles.nl until the date specified as validity (valid until).
- The code indicated on the voucher must be entered into the “Discount coupon / Gift voucher” section in the enter voucher number field when creating an order.
- The value of the voucher is indicated on each voucher as an amount including VAT.
- If the total amount of the order/purchase is:
- higher than the value of the voucher, the customer will pay only the rest of the amount;
- lower than the value of the voucher, the rest of the value is forfeited without compensation (the voucher can only be used in a single order).
- A maximum of one gift voucher can be used in one order.
- The gift voucher is valid only in the country where it was purchased.
- The gift voucher cannot be exchanged for cash.
- In the case of returning the goods paid for with a gift voucher, the amount of these goods is returned by means of a new voucher in the value of the returned goods.
- We add the consequent postage to the stated prices of goods according to the delivery method and address. You can see the complete postage conditions here.
- The seller provides the following additional services:
- Eco-friendly packaging”
- Safe shipping”
- Extension of the return period”
- When ordering at www.dedoles.sk, you may consider, before confirming, whether you want to round the total amount of your order and contribute this difference to the account of the civic association “For Trees”. If you decide so, we will send this difference, which we call "Dedoles change", in the full amount to the account of the civic association "For trees". We usually send the Dedoles change to the account of the civic association „For trees“ in one amount once a month. Your Dedoles change will be listed as a separate item on your invoice. Please note that if you have paid your order in advance or have already taken it over and paid it (whether personal takeover or cash on delivery) and you subsequently decide to return the order with a refund request, we do nor usually refund the amount of Dedoles change, because it is already transferred to the account of the civic association “For trees”. You can see detailed conditions of Dedoles change here.
- The warranty period for all sold goods is set statutory warranty period of 24 months and in case of used goods and second-hand goods at least 12 months and it starts to run from the day of takeover of goods by the Buyer.
- In a case, that the expiration period is marked at the sold product, at its packing or at the attached user manual for this product, the warranty period shall not expire before the expiry of this period.
- Based on the Buyer´s request, the Seller is obliged to provide a warranty in the written form (a warranty certificate). If the nature of goods allows it, it is sufficient to issue a proof of purchase instead of the warranty certificate.
- The warranty certificate shall contain the Seller´s identification (name and surname, the business name or name of the Seller, its seat or place of business), warranty´s content, its extent and conditions, the warranty period and information necessary for the application of the warranty. If warranty certificate does not contain the prescribed essentials, this fact shall not constitute the invalidity of such warranty.
- By means of a declaration listed in the warranty certificate issued to the Buyer or by means of advertisement, the Seller may provide a warranty which exceeds the extent of statutory warranty, the conditions and extent of such a warranty shall be specified by the Seller in the warranty certificate.
- The warranty does not cover normal wear and tear.
- The warranty does not apply to gifts that you receive for free or winnings from competitions.
- The claim to free warranty repair also ceases:
- by failure to present complete goods including accessories,
- by failure to report any obvious defects during the takeover of the goods,
- upon expiry of the warranty period of the goods,
- by unprofessional and careless treatment or neglect of the care of goods,
- by mechanical damage to the goods caused by the Buyer.
- A change of the goods that occurred during the warranty period as a result of their wear and tear, incorrect use or incorrect intervention, cannot be considered to be a defect in particular:
- the defect occurred during the warranty period as a result of wear and tear or incorrect use or insufficient or inappropriate treatment,
- the defect occurred due to natural changes in the materials from which the goods are made,
- the defect occurred as a result of any damage by the Buyer or third party or by other incorrect intervention.
Cancellation of the Order
- If you wish to cancel your order that has not been processed yet, please contact us as soon as possible and include your order number. If your order has already been paid, we will refund the money no later than14 days to the account from which you paid. In the case of payment by card (VISA, MasterCard), this period may be extended due to the bank's procedure during refunding card payments.
- At the same time, we reserve the right to cancel your order for goods if we are unable to deliver it to you due to unavailability (sold out or withdrawal from the offer) or if we are unable to deliver the goods within the agreed time or price, and/or arranging the goods would cause us disproportionate difficulties and disproportionate expenses in proportion to the value of the goods ordered, unless we agree with you on a replacement performance. We will notify you of your cancellation by phone or e-mail without undue In the event of payment of the Purchase Price or part thereof, funds will be refunded to you within 14 days to the account from which you paid, unless otherwise agreed.
- The Seller is responsible for defects which the sold goods have during its takeover by the Buyer.
- If the defects can be removed, the Buyer has a right to get it removed properly, free of charge and in a due time. The Seller is obliged to remove the defects without undue The Buyer may demand, instead of removal of defects, to exchange the goods, or if the defects involve only a part of an object, exchange of this part, if it this does not incur unproportioned costs to the Seller with respect to the price of goods and severity of the defect. The Seller may always, instead of defect removal, exchange the defective goods for goods without defects, if it will not cause significant difficulties for the Buyer.
- In case that the defect cannot be removed, and it prevents the proper usage of goods as the goods without defect, the Buyer shall have a right to exchange the goods or a right to withdraw from the contract. Same rights shall belong to the Buyer, in the case that the defects can be removed, but the Buyer can not properly use the item due to repeated occurrence of defects after the repair or because of a larger number of defects. If the defects cannot be removed, the Buyer shall have a right for an adequate discount from the price of goods.
- The Seller is obliged to indicate the method of handling the warranty claim immediately, in complex cases within 3 working days the latest, from the day of warranty claim´s submission, in justified cases, especially when a complicated technical evaluation of goods or services condition requires it, within 30 days the latest, from the day of warranty claim´s submission. After the indication of method of handling the warranty claim, the warranty claim shall be handled immediately; in justified cases the warranty claim shall be handled later, however, the handling of a warranty claim may not take longer than 30 days from the day of warranty claim´s submission. After the expiration of period for warranty claim’s handling, the Consumer shall have a right to withdraw from the contract or the right for exchange of the goods for new goods.
- The Seller is obliged to confirm the acceptance of warranty claim immediately and shall provide the Consumer with a receipt. The receipt shall be issued together with a document confirming the handling of warranty claim at the latest.
- The time period from the exercise of right to liability for defects until the termination of warranty claim proceedings (handover of repaired goods, written invitation to take the performance over or its justified rejection) shall not be included in to the warranty period. In a case of exchange of goods for new goods, the warranty period for new goods starts to run on the day of its take
- During the warranty claim’s submission by the Consumer during the first 12 months from the purchase, the Seller may handle the warranty claim by rejection only on the basis of an expert opinion, regardless of the expert opinion´s result, it is not possible to require from the Consumer the compensation of costs necessary for the expert´s opinion nor other costs related to expert´s opinion.
- If a warranty claim is submitted by the Consumer after 12 months from the purchase, and is rejected by the Seller, the Seller is obliged to state in the document on warranty claim handling to whom may the Consumer send the product for expert opinion. If the product is sent to expert opinion to determined person, costs of expert opinion as well as all other related costs shall by borne by the Seller regardless of the result of the expert opinion. If the Consumer proves by an expert opinion that the Seller is responsible for the defect, it may submit the warranty claim again. The warranty period does not run during the time of performance of expert opinion. The Seller is obliged to pay the Consumer within 14 days from the day of submission of the warranty claim all related costs reasonably incurred to it. Such a warranty claim shall not be rejected.
- The Buyer will be informed about the result of warranty claim immediately after the termination of the warranty claim proceedings by phone and at the same time warranty claim protocol (proof of warranty claim handling) will be delivered to it by e-mail or by registered post. The document of warranty claim´s handling does not have to be delivered, if the Consumer can prove the submission of warranty claim in a different way.
- In a case of warranty claim submission, the Consumer shall inform the Seller about the warranty claim´s submission via e-mail (in order to achieve the quickest handling of warranty claim) and shall send the goods, packed in a package suitable for shipment together with a description of defect and a copy of purchase document (eventually also with a warranty certificate, if issued) to the Seller’s address:
Keizersgracht 391 A
- The Buyer is entitled to a compensation of inevitable costs which originated in relation to the enforcement of rights to liability for defects.
- If the Consumer is not satisfied with the way in which its warranty claim has been handled by the Seller, or if it is of an opinion that the Seller has violated its rights, the Buyer may address the Seller with a request for remedy. If the Seller rejects such a request or does not respond it at all within 30 days of its submission, the Consumer has a right to file a proposal for an alternative dispute resolution according to 12 of the Act No. 391/2015 Coll. on Alternative Resolution of Consumer’s Disputes and on amendment and supplement to certain acts.
- Alternative disputes resolution may only be used by a Consumer (natural person), who when concluding and performing a consumer contract, does not act within the scope of its business, employment or profession. Alternative dispute resolution concerns only a dispute between a Consumer and a Seller with a value of more than 20 Euro resulting from a distance consumer contract.
- The subject of alternative disputes resolution pursuant to 3 of the Act No. 391/2015 Coll. may charge you a fee of up to € 5 with VAT to initiate a dispute resolution. You may submit a proposal in the manner specified pursuant to § 12 of Act No. 391/2015 Coll. or by clicking on this website https://www.soi.sk/sk/alternativne-riesenie-spotrebitelskych-sporov/formular-pre-podanie-navrhu-na-zacatie-ars.soi.
- The Consumer may use the on-line platform of dispute resolution available on the website https://ec.europa.eu/consumers/odr/main/index.cfm?event=main.home.chooseLanguage for the submission of the proposal for an alternative dispute re
- The relevant subject to alternative resolution of Consumer’s disputes with the Seller Dedoles s.r.o. is the Slovak Trade Inspection
STI Inspectorate with the seat in Trnava for Trnava Region Pekárska 23, 917 01 Trnava 1
phone number: +421335512689
- or other relevant authorised legal person registered in the list of subjects of alternative dispute resolution maintained by the Ministry of Economy of the Slovak Republic (list is available at http://www.mhsr.sk)
Withdrawal from the Contract
- 1. The Customer has a right to withdraw from the contract without stating the reason within 14 days from the day of takeover of the goods according to §7 of the Act N 102/2014 Coll. on Consumer Protection in sale of goods or provision of services based on a distance contract, or a contract concluded outside operational premises of the Seller and on amendment and supplement to certain acts as amended. If the goods were delivered separately within the same order, the withdrawal period shall run from the moment of takeover of the last goods delivered.
- If the delivery of goods constitutes a subject of contract, the Consumer shall have a right to withdraw from the contract before the delivery of goods. If the Customer withdraws from the contract, any additional contract connected with it is also cancelled.
- In accordance with prov. of § 517 (1) of the Civil Code the Customer may apply the withdrawal in relation to the part of the subject of the contract (if the subject of the contract or binding order was the delivery of some pieces of goods) and in such case the contract is cancelled only in this part.
- The Consumer is obliged, if it wishes to exercise this right, to deliver the written withdrawal from the purchase contract personally at the latest on the last day of the specified period to the Seller's contact address or to submit the withdrawal for postal transport at latest on the last day of period to the address stated in contacts. After the notice of withdrawal, the Consumer is obliged to send or deliver personally the subject of the contract from which it withdraws together with all documentation – e.g. a copy of the invoice, instructions and other documentation for the goods delivered to it together with the goods, but no later than 14 days from the date of withdrawal.
- We recommend to Buyers to send the goods via registered mail and as insured shipment.
- Withdrawal from the contract must be made by the Buyer in writing in a manner that does not cause doubts that the withdrawal of the contract has occurred or in the form of an entry on another durable medium or using the form published on https://www.dedoles.nl/exchange-return-claim (to save click on the image, select "Save file" and then fill in and print it).
- Withdrawal from the purchase contract pursuant to the previous point of these Terms and Conditions must contain the information required in the form published on https://www.dedoles.nl/exchange-return-claim , in particular the Buyer's identification, order number and date of the order, the exact specification of the goods, the manner in which the Seller shall return the performance already received, in particular the account number and/or mailing address of the Buyer.
- Do not send the goods by cash on delivery method, the goods delivered in such a manner will not be accepted.
- The operator of e-shop shall return paid performance for goods/service including costs for transport in line with prov. of § 9 (3) of the Act No. 102/2014 Coll. as well as the costs demonstrably incurred to order the goods within 14 days from the delivery of the withdrawal of the contract, however the it is not obliged to return the money sooner than the goods are delivered to it or until the Consumer proves that the goods were sent. This does not apply in a case that the Seller offered to pick up the goods by itself. During the exercise of its right of withdrawal from the contract the Consumer is entitled to reimbursement of costs for the cheapest delivery method offered by the Seller.
- In accordance with § 7 (6) of the Act No. 102/2014 Coll. the Customer may not withdraw from the contract the subject of which is:
- the sale of goods made according to the Consumer’s special demands, tailor-made goods or goods intended specifically for one Customer.
- The Consumer shall bear any deduction of the value of the goods which was caused by its usage beyond what is necessary to ascertain the functionality and characteristics of the goods.
Personal Data Protection
- For more information and exact conditions on personal data, their processing and protection, please visit: https://www.dedoles.nl/processing-of-personal-data-for-marketing
Newsletter and E-mails from you
- During the registration or creation of an order, you can choose to receive regular information on news from us (on average once a week). You can also choose to subscribe to the newsletter individually on the website by entering your e-mail address, or by clicking on the link within the e-mail we sent you. Of course, you can unsubscribe at any time. We will also inform you of your order processing, availability and unavailability of products and we will send you a discount voucher to your e-mail address. We can irregularly (up to several times a year) send all registered customers important information related to the operation of our e-shop and the use of the user account. If you are annoyed by emails, please e-mail us at firstname.lastname@example.org or email@example.com .
- All arrangements between the Seller and the Buyer are governed by the legislation of the Slovak Republic. If the relationship established by the purchase contract contains an international element, the parties agree that the relationship is governed by the legislation of the Slovak Republic. This is without prejudice to the Consumer's rights under general binding legislation.
- The Seller is not bound by any codes of conduct in relation to the Buyer in accordance with the provisions of the Act N 250/2007 Coll. on Consumer Protection as amended.
- All rights to the Seller's website, in particular copyright to the content, including the layout of the site, photos, movies, graphics, trademarks, logos and other content and elements, shall belong to the Seller. It is forbidden to copy, modify or otherwise use the website or its part without the consent of the S
- The Seller shall not be liable for any errors caused as a result of intervention by third parties in the e-shop or as a result of its use contrary to its purpose. When using the e-shop, the Buyer may not use procedures that could adversely affect its operation and shall not engage in any activity that may allow it or third parties to unauthorized intervention or unauthorised use of the software or other components creating the e-shop and use the e-shop, or its parts or software equipment in a manner that would conflict with its function or purpose.
- The purchase contract including Terms and Conditions is archived by the Seller in an electronic form and is not publicly accessible.
- The wording of the Terms and Conditions may be amended or supplemented by the Seller. This provision shall be without prejudice to rights and obligations incurred during the term of effectiveness of the previous wording of the Terms and Conditions.
- The supervision over the compliance with the Seller´s obligations towards the consumer is executed by the Slovak Trade Inspection (STI), in particular the workplace:
- STI Inspectorate with the seat in Trnava for Trnava Region,
- Pekárska 23, 917 01 Trnava 1
- phone number: 033/ 5512 689
- e-mail: firstname.lastname@example.org
- These Terms and Conditions apply as stated on the website www.dedoles.sk on the day of sending the order by the Buyer, who accepts them without reservation, which it also confirms by active clicking on order confirmation. The operator reserves the right to change or supplement the Terms and Conditions. However, closed orders are subject to the wording at the time the order was placed.
- These Terms and Conditions shall come into effect on 1.12.2019 and they cancel the previous wording of the General Terms and Conditions.
FORM FOR CONTRACT WITHDRAWAL
(Please fill in this form and send it only in case you wish to withdraw from the contract)
To whom it may concern:
having its registered office at Za koníčkom 14, Pezinok 902 01, Slovakia
registered with the District Court Bratislava I, Section: Sro, Insert No.: 81976/B.
Company ID. (ICO): 46 706 305
Tax No. (DIC): 2023541630
VAT No. (IC DPH): SK2023541630
Hereby I declare/ we declare (*), that I withdraw/ we withdraw (*) from the purchase contract on these goods/the contract on the provision of a service (*): ..............
Date of order/date of receipt (*) ..............
Name of the Consumer/ Consumers (*) ...............
Address of the Consumer/ Consumers (*) ..............
Signature of Consumer/Consumers (*) (only if this form is submitted in the list form) ..........................
(*) Cross out where not applicable