Regulations

RULES AND REGULATIONS FOR CONCLUDING AGREEMENTS USING TOOL AVAILABLE AT WWW.PASSAN.COM.PL  

These Rules and Regulations define the purchasing principles in the online store run by the Seller at: www.passan.com.pl

The seller is Przedsiębiorstwo Produkcyjno-Handlowe [Manufacturing and Trading Company] “PASSAN” Spółka Jawna [General Parthership] Andrzej Wojciechowski with its registered office in 09-540 Sanniki at ul. Wschodnia 3, Poland, NIP [Tax ID No.]: 7740015864, REGON [National Business Registry No.]: 610039889, entered into the Register of Entrepreneurs of the National Court Register under KRS No. 0000026203 by the District Court for the Capital City of Warsaw in Warsaw, 14th Commercial Division of the National Court Register.  

The Seller may be contacted:

1. by phone: +48 24 2776 200;

2. via e-mail: handlowy@passan.com.pl 

§ 1 Definitions

1. Rules and Regulations – these Rules and Regulations With regard to services provided electronically, these Rules and Regulations shall be the rules and regulations outlined in Article 8 of the Act of 18 July 2002 on the Provision of Electronic Services (Dziennik Ustaw [Polish Journal of Laws] of 2002, No. 144, item 1204, as amended).

2. Buyer – a natural person who has reached at least the age of 13, whereas if such person is under the age of 18, the consent of their legal representative shall be required, as well as a legal person and an organisational unit that is not a legal person, to whom special provisions grant legal capacity, and which places or intends to place an Order or uses other services of the Online Store (including the Consumer and Entrepreneur with consumer rights).

3. Consumer – a natural person who performs a legal act that involves placing an Order for Goods totalling at least EUR 10 and who is not related directly to their business or professional activity.

4. Entrepreneur with Consumer rights – a natural person concluding an agreement related directly to their business activity, when such agreement stipulates that it does not have a professional character for this entrepreneur, stemming, in particular, from the subject of their business activity, made available under the provisions on the Business Activity Central Register and Information Record.

5. Goods – a movable item to which the Agreement applies.

6. Agreement – the Agreement on the Sale of Goods within the meaning of the Civil Code, concluded by and between the Seller and the Buyer, using the Online Store.

7. Online Store – the website available at www.passan.com.pl through which the Buyer can order the Goods.

8. Party – the Seller or the Buyer.

9. Store Website – each page or subpage located at www.passan.com.pl

10. Order – Buyer’s declaration of intent specifying the type and quantity of Goods explicitly, aimed at concluding the Agreement, placed via the Online Store. 

 

§ 2 General principles

1. The Buyer shall have to read these Rules and Regulations and accept their provisions when executing the Order in order to place the Order effectively.

2. The www.passan.com.pl Online Store conducts sales via the Internet.

3. Unless otherwise clearly indicated in the description of the Goods – all Goods offered in the Online Store are brand new, originally packed, free from any physical and legal defects and they have been introduced into the Polish market legally.

4. All Goods are sold in basic commercial packagings, e.g. piece, coil or spool or a package (depending on the type of Goods). Description of each Good includes detailed information about the packaging. 5. The entire Store Website is owned by P.P.H. “PASSAN” Spółka Jawna Andrzej Wojciechowski and is protected by law. All photos and content published on the Store Website may be used for commercial purposes by third parties solely subject to the Seller’s consent made in writing.

6. The colours of the Goods shown in the photos on the Store Website may differ from the actual colours of these Goods (mainly due to the individual settings of screens on which the content of the Store Website is displayed). For this reason, the colour of the Goods which does not match the colour displayed on the screen cannot be deemed a defect in the Goods or its non-compliance with the Agreement. The Seller declares that they can send a sample of the Goods to the Buyer’s address in order to examine its features, especially colour,  before placing the Order Shipment of a sample of the Goods is subject to the Buyer’s request, and the Buyer shall bear the shipping costs.

7. The Online Store executes orders where a place of delivery is the territory of the Republic of Poland as well as orders where a place of delivery is outside the territory of the Republic of Poland.

8. Detailed principles for the conclusion and performance of the Agreement where the place of delivery is the territory of the Republic of Poland are contained in § 3 of these Rules and Regulations.

9. Detailed principles for the conclusion and performance of the Agreement where the place of delivery is outside the territory of the Republic of Poland are contained in § 4 of these Rules and Regulations.  

 

§ 3 Conclusion and performance of the Agreement where the place of delivery is the territory of the Republic of Poland

1. As a standard, all prices listed in the Online Store are gross prices given in Polish zlotys (including VAT).

2. The prices do not include shipping costs.

3. Orders are accepted via https://passan.com.pl

4. Orders can be placed via the Website 24/7/365, except for the holiday/Christmas break, when the acceptance of orders is suspended.

5. The Order is effective if the Buyer completes the order form correctly and provides contact details correctly, including the exact address to which the Goods are to be sent, as well as the phone number and e-mail address.

6. When the provided data is not complete, the Seller will contact the Buyer. If the Seller cannot reach the Buyer, the Seller has the right to cancel the Order.

7. The Buyer consents to issue and send an electronic image of billing documents electronically to the e-mail address provided by them, specifically, documents such as: VAT invoices with attachments, adjustment VAT invoices with attachments and forms. This consent also entitles the Seller to issue and send VAT invoices electronically, in accordance with the regulation of the Minister of Finance of 17 December 2010 on sending invoices electronically, their storage methods and the procedure for making them available to the tax authority or tax inspection bodies.

8. After the Buyer places the Order via the Website effectively, the Store will automatically reply and confirm the acceptance of the Order.

9. The Order’s execution begins its run when the payment is credited to the bank account specified in the Order confirmation in the case of payment by bank transfer or when the Order is placed in the case of cash on delivery method.

10. The Goods are sent to the address indicated in the Order form. The Store will notify the Buyer immediately if the Order form has been completed incorrectly, which prevents or may delay the shipment.

11. The Goods are delivered by companies specialised in services of this kind. In some cases, it is possible to collect the Goods in person from the Seller’s sales office.

12. The shipment is delivered as soon as possible (usually 1-3 days), yet not longer than 30 days following the moment the Seller confirms the acceptance of the Order.

13. The Seller exercises due diligence to ensure that the offer presented on the Website is up-to-date. However, if some of the ordered Goods were not available, the Seller undertakes to immediately notify the Buyer of the situation by phone or e-mail. In such a situation, the Buyer may, at their discretion, withdraw from the Agreement without having to incur any costs or accept a prolonged Order completion date.

14. The Buyer is charged with the delivery (shipping) costs specified in the transport price list available at http://www.passan.com.pl/ in the “Shipping” tab. The amount of fees depends on the type of transport and the method of payment

15. The Seller issues a receipt or invoice (if the Buyer selects the “Please issue a VAT invoice” box when placing the Order) for each and every product sold.

16. Payment for the ordered Goods may be made on a cash on delivery basis (upon receipt of the Goods) or by transfer to the Seller’s bank account. If the Buyer chooses to pay to the Seller’s bank account, failure to credit the payment to the Seller’s account within 7 days of accepting the Order will result in the cancellation of the Order.

17. In the case of an Order exceeding PLN 3,000.00 or products with an annotation “on request” in the records, the Seller reserves the right to change the payment method by requesting a prepayment of all or part of the Order’s value. This limitation does not apply to Consumers and Entrepreneurs with Consumer rights.  

 

§ 4 Conclusion of the Agreement where the place of delivery is outside the territory of the Republic of Poland

1. After making an appropriate selection in Online Store’s menu, the prices of the Goods may be given in currencies other than Polish zloty, i.e., EUR and USD. The prices are then gross (including VAT).

2. The prices given in the Online Store in PLN, EUR and USD do not include shipping costs and additional fees resulting from applicable law (e.g., customs) and are only an estimate. The final prices including all constituents and delivery costs are set in the pro-forma invoice sent to the Buyer to the e-mail address provided when placing the Order. The prices of the Goods shown in the pro-forma invoice will be determined based on the exchange rates published by the National Bank of Poland on the date of placing the Order, delivery costs will be determined in line with the price list of the courier company in force on the date of placing the Order, and additional fees will be determined in line with the relevant legal regulations in force on the date of placing the Order. The Seller does not charge any other additional fees (not provided for by law) related to the preparation of the Goods for shipment outside the territory of the Republic of Poland.

3. When the Buyer places an Order, it is neither tantamount to the conclusion of the Agreement nor does it give rise to any obligations for the Buyer. Placing an Order by the Buyer only gives rise to Seller’s obligation to draw up a pro-forma invoice referred to in the above Item and send it to the Buyer’s e-mail address no later than within five business days of placing the Order by the Buyer.

4. Sending a pro-forma invoice by the Seller is a proposal to conclude the Agreement.

5. The Agreement is concluded only after the Buyer has replied about the acceptance of the Order value and delivery costs specified in the pro-forma invoice. The Buyer may accept the Order value and delivery costs by any explicit declaration addressed to the Seller via means of distance communication indicated by the Buyer when the Order (including, in particular, e-mail, fax, phone).

6. The Buyer may refuse to accept the Order value and delivery costs without paying any consequences. If the Seller does not receive the Buyer’s declaration of the acceptance of the Order value and delivery costs specified in the pro-forma invoice within five business days of sending it to the Buyer’s e-mail address, it will be tantamount to a refusal to accept the Order value or delivery costs and cause the cancellation of the Order without incurring any costs by the Buyer.

7. Sales outside Poland on the basis of a VAT invoice is at net prices (excluding VAT), if the Buyer, when placing the Order, indicates their Tax ID Number (NIP).

8. Orders are accepted via https://passan.com.pl

9. Orders can be placed via the Website 24/7/365, except for the holiday/Christmas break, when the registration of orders is suspended.

10. The Buyer consents to issue and send an electronic image of billing documents electronically to the e-mail address provided by them, specifically, documents such as: VAT invoices with attachments, adjustment VAT invoices with attachments and forms. This consent also entitles the Seller to issue and send VAT invoices electronically, in accordance with the regulation of the Minister of Finance of 17 December 2010 on sending invoices electronically, their storage methods and the procedure for making them available to the tax authority or tax inspection bodies.

11. The Order’s execution begins its run when the amount specified in the pro-forma invoice is credited to the bank account specified in the pro-forma invoice sent to the Buyer.

12. The Goods are sent to the address indicated in the Order form. The Store will notify the Buyer immediately if the Order form has been completed incorrectly, which prevents or may delay the shipment.

13. The Goods are delivered by companies specialised in services of this kind.

14. The shipment is delivered as soon as possible (usually 2-5 days), yet not longer than 30 days following the moment the Seller receives the acceptance of the amounts indicated in the pro-forma invoice.

15. The Seller exercises due diligence to ensure that the offer presented on the Website is up-to-date. However, if some of the ordered Goods were not available, the Seller will notify the Buyer of it when sending the pro-forma invoice.

16. The Buyer is charged with the delivery (shipping) costs specified in the pro-forma invoice.

17. The Seller issues an invoice for every Goods sold.

18. Payment for the ordered Goods may be made only by transfer to the Seller’s bank account indicated in the pro-forma invoice. If the payment is not credited to the Seller’s bank account within 7 days of accepting the amounts indicated in the pro-forma invoice, it will result in the cancellation of the Order.

19. In the case of Orders placed by Consumers and Entrepreneurs with Consumer rights, payment for the ordered Goods may also be on cash on delivery basis – if such a Buyer clearly indicates such a form of payment in the declaration of the acceptance of the amounts indicated in the pro-forma invoice. In this case, the Buyer is, however, obliged to pay to the Seller’s bank account the amount corresponding to the value of the delivery costs specified in the pro-forma invoice. If the payment of this amount is not credited to the Seller’s bank account within 7 days of accepting the amounts indicated in the pro-forma invoice, it will result in the cancellation of the Order.  

 

§ 5 Right to the withdrawal

1. The Consumer and the Entrepreneur with Consumer rights have the right to withdraw from the Agreement within 14 days of its conclusion without having to justify it.

2. The time limit for the withdrawal from the Agreement will expire after 14 days of the date when the Consumer or the Entrepreneur with Consumer rights has taken physical possession of the Goods or when a third party other than the carrier and indicated by the Consumer or the Entrepreneur with Consumer rights has taken physical possession of the Goods.

3. To exercise the right to withdraw from the Agreement, the Consumer or the Entrepreneur with Consumer rights must notify the Seller of their decision to withdraw from the Agreement by an unequivocal declaration (e.g., a letter sent by post, fax or e-mail). The declaration in question should be sent to the following address: PPH PASSAN Sp. J. Andrzej Wojciechowski ul. Wschodnia 3, 09-540 Sanniki, Poland or handlowy@passan.com.pl

4. The Consumer or the Entrepreneur with Consumer rights may use the  Agreement withdrawal form template (available in the Withdrawal from the Agreement tab at www.passan.com.pl), yet it is not obligatory.

5. In order to meet the time limit for withdrawing from the Agreement, it is sufficient if the Consumer or the Entrepreneur with Consumer rights sends information regarding the exercise of their right to withdraw from the Agreement before the expiry of the statutory withdrawal period.

6. In the event of withdrawal from the Agreement, the Seller will reimburse for all payments received from the Consumer or the Entrepreneur with Consumer rights without undue delay, including delivery costs (except for additional costs resulting from the method of delivery chosen by the Consumer or the Entrepreneur with Consumer rights, other than the cheapest standard delivery method offered by the Seller), and in any case not later than 14 days of notifying the Seller by the Consumer or the Entrepreneur with Consumer rights of their decision to exercise the right to withdraw from the Agreement. The Seller will reimburse for the payment using the same payment methods as in the original transaction, unless the Consumer or the Entrepreneur with Consumer rights agrees to a different solution expressly (e.g., reimbursement to the indicated bank account, which should be reflected in the content of the declaration of withdrawal from the Agreement). In any case, neither the Consumer nor the Entrepreneur with Consumer rights will incur any fees related to such reimbursement.

7. In the event of withdrawal from the Agreement, the Consumer or the Entrepreneur with Consumer rights should return the Goods within 14 days of submitting the declaration of withdrawal from the Agreement, to the following address: PPH PASSAN Sp. j. Andrzej Wojciechowski, 09-540 Sanniki, ul. Wschodnia 3, Poland. Within this period, the Consumer or the Entrepreneur with Consumer rights may also personally deliver the Goods to the Seller’s registered office or sales office. Failure to meet the 14-day time limit results in the expiry of the rights of the Consumer/Entrepreneur with Consumers rights to withdraw from the Agreement.

8. The Consumer or the Entrepreneur with Consumer rights will have to bear the direct costs of returning the Goods.

9. The Consumer and the Entrepreneur with Consumer rights hold liability for any reduction in the value of the Goods resulting from handling them differently than necessary to establish the nature, features and operation of the Goods.

10. The Seller may withhold the reimbursement for the amounts received from the Consumer or the Entrepreneur with Consumer rights until the Goods are returned or until the Consumer or the Entrepreneur with Consumer rights provides proof of their return, whichever occurs first.

11. The Seller does not collect “COD” shipments.

12. The possibility of returning the Goods does not apply to those Goods prepared upon a special request of the Consumer or the Entrepreneur with Consumer rights.  

 

§ 6 Seller’s liability for defects in the Goods

1. The Seller is liable towards Buyers for physical and legal defects in the Goods on the terms stipulated in the Civil Code Act in the provisions governing the warranty, in the wording in force upon concluding the Agreement (Article 556-Article 576.4, subject, however, to the following changes.

2. Any further Seller’s liability – other than the obligation to remedy the defect, reduce the price accordingly or deliver defect-free Goods instead of the defective Goods – is excluded (including, in particular, the Seller is not obliged to cover the Buyer’s lost profit).

3. Before collecting the shipment, the Buyer is obliged to check whether the packaging has not been damaged during transport or not. In particular, it is necessary to pay attention to the condition of the tapes adhered to the shipment. If the shipment’s packaging is damaged or the tapes are ripped, the Buyer shall not accept the shipment and prepare a damage report in the presence of the carrier as well as contact the Seller immediately to clarify the matter. Failure to find any irregularities in the quantitative or qualitative condition of the shipment upon delivery exempts the Seller from liability for defects in the Goods.

4. The restrictions imposed by the Rules and Regulations in relation to the provisions of the Civil Code regarding warranty do not apply to Consumers or Entrepreneurs with Consumer rights.

 

§ 7 Privacy policy and personal data protection

1. The Seller is the controller of databases of personal data provided by customers of the Online Store in connection with purchases.

2. The Seller processes the Buyer’s personal data in line with Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (OJ UE.L No. 119, p. 1) (hereinafter: GDPR) and other currently applicable provisions of the law on personal data protection.

3. The Seller undertakes to observe the confidentiality related to the Buyer’s data and not to disclose this data to any unauthorised third parties as well as to secure this information properly against access by any unauthorised third parties.

4. Detailed rules for the processing of personal data are governed in the Privacy Policy and the Cookies Policy.  

 

§ 8 Service Agreement and technical requirements

1. In order to use the Online Store, it is necessary that the devices and systems used by the Buyer meet the technical requirements as follows: the Buyer must have a computer or other devices connected to the Internet, with one of the following web browsers installed (in the versions as indicated or later): Microsoft Internet Explorer 10.0, Firefox 43.0, Google Chrome 48.0, Safari 5.0, Opera 36.0, Microsoft Edge 13.0 that supports JavaScript and allows saving cookies.

2. The Service Agreement is concluded by registering an Account, which takes place when the user completes and accepts the registration form and sends it to the Seller.

3. The Service Agreement is concluded for an indefinite period.

4. By the Online Store, the Seller enables the Buyers to create the Account, conclude Agreements or submit a proposal to conclude an Agreement, as well as to use the services of the Basket or the Clipboard. Only those Buyers who have registered the Account can conclude Agreements via the Online Store unless the Seller has extended this possibility also for unregistered Buyers.

5. The Online Store gives the Buyers the opportunity to read the content published therein, as well as simplified statistics of interest in the Goods.

6. By using the Online Store, the Seller may present the Buyers with advertising materials customised to their interests.

7. When the Buyer has created the Account, the Seller – using the Online Store – provides them with services of maintaining sessions, purchase history, giving opinions, asking questions about the Goods.

8. The Buyer’s obligations include above all: - providing truthful and current data in the forms to the extent required by the respective form, - updating this data on an ongoing basis, - using the Online Store in line with the law, these Rules and Regulations and morality, - not transferring within the Online Store content prohibited by law, violating good manners, personal rights of other people or copyrights, - using the Online Store contrary to operations of the Seller, the Online Store and inconveniently for other people, - not modifying the content provided by the Seller, - refraining from taking steps that involve posting or sending non-ordered commercial information, - refraining from taking steps to obtain information not intended for the Buyer. The Service Agreement may be terminated at any time, effective immediately, by deleting the Account. Such a solution is ineffective with regard to the Orders in progress.

9. The Seller may terminate the Service Agreement and limit the possibility of using the Online Store only due to important reasons. The Service Agreement is terminated in a documented form, effective immediately. These important reasons include, primarily: violating personal rights of third parties by the Buyer, providing false data, violating these Rules and Regulations grossly.  

 

§ 10. Final provisions

1. To matters not covered by these Rules and Regulations, the relevant provisions of Polish law, including the Civil Code and other acts, shall apply.

2. The jurisdiction of Polish courts and Polish procedural regulations apply to the settlement of disputes related to sales under these Rules and Regulations. This provision, however, does not apply to Consumers and Entrepreneurs with Consumer rights.

3. Detailed information on the Consumer’s possibility to use non-judicial means of dealing with complaints and asserting claims is available at the offices and on the websites of district (municipal) consumer ombudsmen, social organisations whose statutory tasks include consumer protection, Provincial Inspectorates of Trade Inspection and at the following internet addresses of the Office of Competition and Consumer Protection:

http://www.uokik.gov.pl/spory_konsumenckie.php;

http://www.uokik.gov.pl/sprawy_indywidualne.php

http://www.uokik.gov.pl/wazne_adresy.php.

The Seller agrees to solve disputes out-of-court.   The Consumer is vested in the following example possibilities of using non-judicial means of dealing with complaints and asserting claims: the Consumer may apply to a permanent consumer arbitration court, referred to in Article 37 of the Act of 15 December 2000 on the Trade Inspection (Dziennik Ustaw of 2001, No. 4, item 25, as amended), with a request to settle a dispute arising from the concluded Sales Agreement. The rules of organisation and operation of permanent consumer arbitration courts are specified in the regulation of the Minister of Justice of 25 September 2001 on the Rules of Organization and Operation of Permanent Consumer Arbitration Courts (Dziennik Ustaw 2001, No. 113, item 1214); the Consumer may apply to the provincial inspector of the Trade Inspection, in accordance with Article 36 of the Act of 15 December 2000 on the Trade Inspection (Dziennik Ustaw of 2001, No. 4, item 25, as amended), with a request to initiate mediation proceedings on the amicable settlement of the dispute between the Consumer and the Seller. Information on the rules and procedure of the mediation procedure conducted by the provincial inspector of the Trade Inspection is available at the offices and on the websites of respective Provincial Inspectorates of the Trade Inspection. the Consumer may get assistance in resolving the dispute between the Consumer and the Seller using the support of a district (municipal) consumer ombudsman or a social organisation whose statutory tasks include consumer protection (e.g., Consumer Federation).

4. Any and all disputes arising from the performance of the Agreements concluded with the application of these Rules and Regulations will be settled by the courts competent for the Seller’s registered office. This provision, however, does not apply to Consumers and Entrepreneurs with Consumer rights.

5. The Seller reserves the right to amend these Rules and Regulations, with the proviso that any agreements concluded before the amendment to these Rules and Regulations are governed by the version of these Rules and Regulations in force when the Buyer has placed the Order.

6. These Rules and Regulations become effective on the day of their publication in the Online Store.  

 

 

RIGHT TO WITHDRAWAL  

As Consumers and natural persons concluding an agreement related directly to your business activity, when such agreement stipulates that it does not have a professional character for you, stemming, in particular, from the subject of your business activity, made available under the provisions on the Business Activity Central Register and Information Record, you have the right to withdraw from such agreement within 14 days without having to justify it.  

The withdrawal time limit will expire after 14 days of the date when you or a third party other than the carrier and indicated by you have taken physical possession of the goods.  

To exercise your right to withdraw from the agreement, you must notify us i.e., Przedsiębiorstwo Produkcyjno-Handlowe [Manufacturing and Trading Company] “PASSAN” Spółka Jawna [General Parthership] Andrzej Wojciechowski with its registered office in 09-540 Sanniki at ul. Wschodnia 3, Poland, NIP [Tax ID No.]: 7740015864, REGON [National Business Registry No.]: 610039889, entered into the Register of Entrepreneurs of the National Court Register under KRS No. 0000026203, telephone and fax number: +48 24 2776 200, address e-mail: export@passan.com.pl of your decision to withdraw from the agreement by means of an unequivocal declaration (for example, a letter sent by post, fax or e-mail).  

You may use the agreement withdrawal form template, yet it is not obligatory.  

In order to meet the time limit for withdrawing from the agreement, it is sufficient if you send information regarding the exercise of your right to withdraw from the agreement before the expiry of the withdrawal period.  

Effects of withdrawal from the agreement. If you withdraw from the agreement, we will reimburse for all payments received from you without undue delay, including the costs of delivering the goods (except for additional costs resulting from the method of delivery chosen by you other than the cheapest standard delivery method offered by us), and in any case no later than 14 days of when you have notified us of your decision to exercise the right to withdraw from this agreement. We will reimburse for the payment using the same payment methods as in the original transaction, unless you have agreed otherwise expressly; in any case, you will not incur any fees as a result of this reimbursement. We may withhold the reimbursement until we receive the goods or until proof of its return is provided to us, whichever occurs first.  

Please send back or hand over the goods to us immediately, and in any case not later than 14 days of when you have notified us of your withdrawal from this agreement. The time limit is deemed met if you send back the goods before the period of 14 days has expired.  

You will have to bear the direct costs of returning the goods.  

You are only liable for reducing the value of the goods resulting from using them differently than necessary to establish their nature, features and operation.  

 

  __________________________ dated ________________ (place, date)

 

_____________________________

_____________________________

_____________________________

_____________________________

 (name, surname, address of the person exercising of the right of withdrawal)

PPH PASSAN Sp.j. Andrzej Wojciechowski

ul. Wschodnia 3

09-540 Sanniki

POLAND handlowy@passan.com.pl

tel. +48 24 2776 200  

 

DECLARATION OF WITHDRAWAL FROM THE AGREEMENT  

 

I hereby inform you about my withdrawal from the Agreements for the sale of the following goods:

- ______________________________________________________________________

- ______________________________________________________________________

- ______________________________________________________________________

- ______________________________________________________________________

Order date: ________________________________________________________

Collection date: ____________________________________________________________

Order number: ________________________________________________________

Sales document number (optional): _____________________________________

Please reimburse for the amounts paid for the above Goods to the bank account No. (optional): _____________________________________________________________  

 

__________________________________

(signature of the declarant – not required when sending the declaration by e-mail)  

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