General Terms and Conditions for Individuals

of Company Mongata s.r.o.

for Talk2amy platform (for consumers)

1. INTRODUCTORY PROVISIONS

1.1. These General Terms and Conditions (hereinafter referred to as the "GTC") form an integral part of any contract concluded between the Provider and the Customer. Where a contract is referred to, this also means these GTC.

1.2. These GTC are an integral part of the General Agreement, which is concluded when establishing the Subscription and the User Account, with these GTC further regulate the rights and obligations of the parties. This also applies to the Sub-Agreement, which is concluded when the Customer purchases a paid service to add Profiled Person, Questionnaire, or other paid product.

1.3. The Contracting Parties may derogate from these GTC by agreement between the two Contracting Parties.

1.4. In the event of a conflict between the GTC and a particular Contract, priority shall be given to the wording of a particular Contract.

1.5. The Provider is entitled to change these GTC unilaterally. The Provider shall inform the Customer of this change no later than 14 (fourteen) days before the change takes effect. The Customer has the right to refuse the change of the GTC by written notification to the Provider delivered no later than 7 (seven) days before the change took effect. With this written notice, the Provider simultaneously terminates the Contract (Framework Agreement). In such a case, the notice period is 7 (seven) days.

1.6. These GTC contain references to the possibilities of purchasing in the Store and purchasing individual paid services. These services are still being prepared and will be implemented gradually. It may therefore not be available at the time of publication of these GTC.

2. BASIC TERMS

2.1. The following capitalized terms have the following meanings in these GTC:

Administrator - the person who establishes and chooses the form of the Subscription. The Administrator also invites Clients to Subscription and Guests to complete questionnaires

Subscription - part of the resources and functions of the Platform defined by the Customer under the Contract and these GTC. In this section of the Platform, Customer may manage data and other people's access to such data and features. Subscription is established, changed, and managed by the Administrator for the benefit of the Customer. Marketing term for the Subscription for individuals is “My Amy”

Price - price for each Profiled Person and, where applicable, paid Questionnaires and other products set by the Provider's price list

Sub-contract - a sub-contract for the provision of services consisting in the provision of services (in particular the execution of Questionnaires) by the Provider concluded between the Provider and the Customer on the basis of the General Agreement

Guest - a natural person whom the Administrator invites as part of the Subscription to complete questionnaires without the need for registration

Customer - the person with whom the Provider concludes a contract for the provision of services and which is invoiced Price. In Anonymous mode, this is the person who fills out questionnaires. The Customer is always a person over 15 years of age. Within these GTC, the Customer means a consumer, i.e. a natural person who does not act in the course of his business activity or in the independent exercise of his profession

Platform - Talk2amy platform operated on the websites:

• https://client.talk2amy.com - version for registered and Guests
• https://support.talk2amy.com - Platform support for all types of users
• https://lite.talk2amy.com - anonymous version - Anonymous mode. This version is commercially called LITE.

Provider - Mongata s.r.o., ID: 089 60 585, with registered office at Plynární 1617/10, Prague 7, zip code 170 00

General Agreement - a framework service contract concluded between the Provider and the Customer, which envisages the conclusion of Sub-contracts

Contract - General Agreement, Sub-Contract, and Anonymous Agreement; any Contract is concluded for an indefinite period

Questionnaire - online Questionnaire for the purpose of profiling the personality and analyzing its character and other characteristics provided by the Provider within the Platform; the Questionnaire may be paid or completed free of charge

User Account (User) - An account within the Platform that contains a username, password, and personal settings. With this account, the individual authenticates him/herself within the Platform. A single User can be part of multiple Subscriptions. The roles assigned to the User may differ between Subscriptions. Within one Subscription, the User may hold multiple roles

Client - a natural person whom the Administrator invites to register his/her own User Account and to complete the Questionnaire

Store - functional part of the Subscription, where the Administrator can purchase additional Questionnaires and other products for himself or others

Full Version (Paid version) - defines the Services of the Platform and their Price. The Price for the Full Version is determined by the number of people who use the Full Version; The Price is paid once for each Profiled Person, including the Customer. As part of the Full Version, the Customer may use questionnaires for all Profiled Persons for whom he/she has paid a one-time payment; The questionnaire can only be completed once by each Profiled Person

Free version – the Customer can also use the Platform free of charge (it is a LITE version); such a version is functional, however, it does not contain all tools and options such as the Full Version

Profiled Person - Client, Member or Guest who fills in a paid or free Questionnaire.

3. SPECIFICATIONS OF SERVICES

3.1. The platform is a support psychological platform based on statistics and artificial intelligence that helps people understand and further develop and work with their personality. The platform also allows you to work with other people's personality profiles.

3.2. Based on Questionnaires and other inputs, the platform creates a profile of the personality with whom it continues to work within the Profiled Person and, according to his/her choice, compares the results with selected profiles, creates development plans for the tested person, etc.

3.3. The platform can clearly explain the specifics of a particular personality and identify possible areas of further development. This helps people understand themselves and others, find new talents, create effective teams, as well as provide professional diagnostics. The platform is available on the website of:

• https://client.talk2amy.com - version for registered and Guests
• https://support.talk2amy.com - Platform support for all types of users
• https://lite.talk2amy.com - anonymous version - Anonymous mode. This version is commercially called LITE.

3.4. The platform can be used both in Registration mode and in Non-registration mode, i.e. in Anonymous mode. In Registration mode, the person first selects the Subscription type, which is always an "Individual" Subscription for the consumer and then creates a Subscription in which he/she creates his/her User Account, where he/she fills in the required data, such as first name, surname, email and password.

3.5. After the Subscription creation, a confirmation of the creation of the Subscription or account is sent to the specified email via a hyperlink. The Subscription and User Account are activated and therefore created regardless of the hyperlink click. Clicking on the link confirms the email address.

3.6. In Anonymous mode, the Customer is allowed to complete some Questionnaires without the need to register the User Account and pay the Price. In other cases, the Administrator must choose the Full Version. By confirming the order of paid Products, the Customer is obliged to pay the Price according to the valid Price list via the payment gateway.

3.7. The services provided by Platform and described in these GTC vary depending on whether they are provided under the Full Version or the Free Version.

3.8. For the Platform to function properly, the Customer's device must meet at least the following conditions:

a) The browser you are using must be one of the supported browsers:
1) Microsoft Edge (latest version)
2) Internet Explorer 11 (supported until March 31, 2021)
3) Safari (latest version, Mac only)
4) Chrome (latest version)
5) Firefox (latest version)
b) The browser used must be enabled:
1) Soubory Cookies
2) JavaScript
c) The network/firewall used must be enabled:
1) Cookies - technical cookies for security and running reasons
2) Secure HTTP (HTTPS)
3) Secure WebSockets (WSS)
4) Emails from the talk2amy.com (not required for LITE version)
d) The Internet connection used must be stable with the following throughput for one User:
1) Minimum: 5 Mbps
2) Optimal: 10 Mbps

The Customer acknowledges that if the device on which he/she uses or wants to use the Platform does not meet the above conditions, the Provider does not guarantee the full /proper functioning of the Platform.

4. SUBSCRIPTION FOR INDIVIDUALS (Full Version)

4.1. The Subscription for Individuals is intended for individuals over the age of 15 who will use the Services of the Platform for their personal use and the needs of their loved ones and friends. This Subscription cannot be used for commercial purposes.

4.2. The personal need referred to in the preceding paragraph is without prejudice to the possibility of transmitting the results of questionnaires to a third party or sharing the results of questionnaires with a third party designated by him.

4.3. To use the Platform services in the Full Version Subscription, the Customer is obliged to create a Subscription via the registration form at: https://client.talk2amy.com/signUp/welcome or directly from LITE version.

4.4. The Subscription creation is free of charge. If we speak further about Subscription and User Account, this applies only to the Full Version.

4.5. The use of the Subscription under the Free Version is free of charge; the use of the Full Version is subject to payment of the Price according to the number of Profiled Persons (including the Customer).

4.6. When creating a Subscription, the Customer simultaneously establishes a User Account or assigns a previously created User Account to the Subscription.

4.7. The Customer is obliged to fill in the Subscription data truthfully and completely and to keep the data up to date throughout its registration. The Customer may correct and change the data entered in the registration form at any time in the Subscription.

4.8. The User registering in the system is obliged to fill in the data about the User Account truthfully and completely and to keep the data up to date throughout his/her registration. The User may correct and change the data entered in the registration form at any time in the Subscription.

4.9. After sending the User Account data, a confirmation email with a link is sent to the e-mail address specified by the User, after which opening the specified e-mail address is verified. If the User does not verify the e-mail address via confirmation e-mail, he/she is not allowed to enter payment details. A message about the need to verify the email will also appear whenever you log in to the Platform. Verifying your email address does not affect the creation of a User Account.

4.10. By establishing the Subscription, the Customer agrees with these GTC and concludes a Framework Agreement, which is concluded for an indefinite period and electronically in one of the supported languages selected by the User. Information about the Subscription and its contents is located in the Account, where the User can manage it himself/herself. All agreed legal documents can be found in the Account Settings section.

4.11. In the Subscription, the Customer may

(i) fill in assigned Questionnaires in the "Me" section, even questionnaires that are not paid. Furthermore, use other features related to this,
(ii) Select and purchase any paid Questionnaire and other products in the Store section by clicking on the "Buy" button, both for yourself and for other Users connected to their Subscription,
(iii) invite other individuals (Profiled Persons) to join the Subscription so that they can complete questionnaires. Furthermore, use other features related to this,
(iv) update data, Subscription, or add Profiled People.

4.12. As part of the Individual Subscription, it is always necessary to pay the Price for at least one person (Customer), additionally for each Profiled Person. In addition, it is always possible to purchase any paid Questionnaire or other Product through the Store after logging into the User Account.

4.13. By clicking on the "Buy" button, the Customer's chosen order is summarized for the paid order (adding the Profiled Person, purchasing the Questionnaire or another Product) and provided with the following information:

(i) identification and contact details of the Provider,
(ii) identification of the Services and description of their main characteristics,
(iii) The Price and method of payment,
(iv) information on rights from defective performance and conditions and their exercise, including withdrawal from the contract,
(v) the duration of the commitment and the possibility of terminating it,
(vi) functionality of digital content and technical protective measures,
(vii) how to store and allow access to the Sub-Contract,
(viii) the possibility of detecting and correcting errors arising when registering an account,
(ix) a reference to these GTC.

4.14. If the Customer agrees to the summary of the order, he/she will make a binding order for the paid Product by clicking on the "Complete Purchase" button.

4.15. By binding order of a Paid product according to the previous paragraph (or by binding order via e-mail), the Customer undertakes to pay the Price for the addition of a person (Profiled Person or Customer), a Questionnaire or other paid product according to the valid Price list.

4.16. Due payment of the Price concludes a Sub-contract is for the given paid Service (Product). The Customer is only allowed to use the ordered paid Service (Product) after full payment of the Price only.

4.17. After fulfilling all the above conditions (after paying the relevant Price or after binding order), all Users within the Customer’s Subscription, while respecting their roles, are allowed to start using the functions associated with the paid Service (Product), fill out the selected Questionnaire or use other purchased Products. In the event that the Customer purchases a paid Questionnaire or other Product that can be used for multiple Profiled Persons, he/she is entitled to assign this Questionnaire to one or more Profiled Persons of his choice. These Profiled Persons can complete the Questionnaire by logging into their User Account; the Profiled Person learns about the assignment of the Questionnaire by e-mail or by logging into the User Account. The questionnaire can only be completed once by each Profiled Person if the Customer does not use a paid service that allows the questionnaire to be completed multiple times.

4.18. The results of the Questionnaire completed by Clients are stored in the Subscription and Clients can see, combine, compare or otherwise work with them and display them at any time. The Client does not have access to the results of another Client. However, the Customer has access to the results of all Clients – but only if the Clients agree.

4.19. The results of the Questionnaire completed by Guests are stored in the Subscription and Guests cannot view them; however, they can be seen by the Customer or the User.

4.20. Administrator or, in Individual mode, can invite any person as part of their Subscription

• Guest - to complete the Questionnaire without registration,
• Client - to create a User Account, to complete the Questionnaire and to use the designated functions of the Subscription; its creation is the same as for the creation of any other User Account according to these GTC, with the fact that a separate Subscription is not created, but it is assigned to the Customer's Subscription,

by entering his/her email address and sending invitation. In this case, the Customer is responsible for processing the Profiled Person's email address as personal data according to the relevant legal regulations or other personal data that he enters the Platform.

4.21. After entering the Profiled Person's e-mail, a unique hyperlink is sent to the specified e-mail. By clicking on this link, the Profiled Person is redirected to the Platform, where he/she creates a User Account (only in the case of the Client) and/or is allowed to complete the Questionnaire. The Profiled Person is always informed about who invited him/her to fill in the Questionnaire.

4.22. If the Profiled Person does not agree to share the results with the Customer, this does not affect his/her permissions and the possibility to complete the Questionnaire in his/her own Subscription mode without sharing his Questionnaire result with the Customer who invited him to complete the Questionnaire.

5. ANONYMOUS MODE - LITE VERSION (Free version)

5.1. The Anonymous mode is intended for natural persons who wish to complete one of the free Questionnaires for their personal use, without registration.

5.2. In Anonymous Mode, the Customer does not provide the Provider with any personal data.

5.3. To complete the Questionnaire in Anonymous mode, the Customer clicks on the web address https://lite.talk2amy.com . He/she will then be provided with the following information:

(i) identification and contact details of the Provider,
(ii) identification of the Services and description of their main characteristics,
(iii) the functionality of digital content and technical protective measures,
(iv) the manner in which the Agreement is deposited and may be accessed,
(v) a reference to these GTC.

5.4. After the Questionnaire is completed, the Customer is shown the result of the Questionnaire with a return hyperlink in case the Customer wants to return to the questionnaire result.

5.5. The Customer acknowledges that Questionnaires performed in Anonymous mode and interpretations of their results have a lower interpretation value than questionnaires and features available in registered Subscriptions. These are sample questionnaires, indicative, which do not work with such sophisticated methods of their evaluation. Selected features of the Platform also may not be available.

6. PRICE

6.1. The Customer is obliged to pay the Price to the Provider according to the currently valid Price List.

6.2. The currently valid Price List is available on the Provider’s website of the https://www.talk2amy.com and its relevant part is also presented to the Customer before binding ordering of the given paid Service (Product).

6.3. The Price is paid by direct payment via the payment gateway of an external company. Payment takes place before the Customer is allowed to use the paid Service (product).

6.4. Paid Questionnaires may be paid from the number of uses (these Questionnaires can be completed and thus assigned to only a limited number of persons; this information is always presented for the given Questionnaire, including an indication of the number of uses, with each Profiled Person being able to complete the Questionnaire only once at a time).

6.5. If the Customer purchases a specific paid Questionnaire or Product, its use may be accessed later, but no later than one year after purchase, i.e. it is not necessary to complete the Questionnaire immediately.

6.6. Proof of receipt of payment is provided to the Customer according to the conditions of the external company operating the payment gateway, or Provider.

6.7. In the event of a refund of any payment or part thereof, the relevant part of the funds is deposited as a so-called credit. In case of drawing on any service that is paid, the Price according to the Price List will be lowered by the amount of the current credit.

6.8. In the event that for any reason the Subscription is cancelled or terminated and the amount of the current credit is more than CZK 0, this credit will be fully refunded.

7. QUESTIONNAIRE

7.1. At the beginning of the Questionnaire, the Profiled Person may be requested to provide more detailed information about himself/herself. Filling in this data greatly helps to evaluate the Questionnaire, but it is not necessary. These data are e.g. country of origin, age, gender, native language, etc.

7.2. The Profiled Person may interrupt the filling out of the Questionnaire at any time and return to the Questionnaire where it was interrupted within 1 hour. If the Profiled Person does not return to complete the Questionnaire within 24 hours, the filling history will be erased, and the Profiled Person must complete the Questionnaire from the beginning.

7.3. Questionnaires are evaluated automatically, and the results are available immediately after the Questionnaire is completed.

7.4. Questionnaires and results of Questionnaires are for informational purposes only.

7.5. The Digital Content of the Platform and its functionality require that the User or Guest has at their disposal hardware and software to open and play digital content within the Internet browser. In order to use digital content, it is essential that the User or Guest is connected to the Internet with sufficient connection speed (minimum 5Mbps, optimally 10Mbps) and is physically in the country where the Platform services are provided.

7.6. Both the Customer and the Profiled Person (as well as other persons) acknowledge that the results of the Questionnaire are based on statistics and predictions and cannot in any way be considered as an assessment of the health or mental state of the Profiled Person. If the Questionnaires were evaluated using a different methodology than the one used by the Provider within the Platform, the results could be different.

7.7. In case of any concern for a medical or psychological condition, it is necessary to contact a doctor. The Platform with its Services does not replace counselling or clinical psychologists. The platform's activities are not the provision of health or other similar services under applicable legislation.

7.8. The results of the Questionnaires do not replace the diagnosis or other assessment of an individual's mental or health condition; only the doctor is competent to do so.

8. RIGHTS AND OBLIGATIONS OF THE PROVIDER

8.1. The Provider shall not be liable for any malfunction or reduction of functionality or functionality of the Platform caused by a malfunction or other obstacles due to third-party reasons (power outage, data network, etc.), force majeure or planned or unplanned shutdown of the Platform for the purpose of checking or maintaining hardware, software or websites.

8.2. The Provider reserves the right to provide Services only in selected countries.

8.3. Subscription and/or Price may vary across selected countries.

8.4. The Provider shall not be liable for any decision made by the Customer or the User or any person acting on behalf of the Customer on the basis of the results of the Questionnaires or the use of other products or in connection with them.

8.5. The Provider shall not be liable for any successes or failures of the Profiled Person.

8.6. The Provider does not guarantee in any way and to any extent that following the results of questionnaires and negotiations, even if such action is in accordance with them, will bring any benefit, advantage, success or failure to the Profiled Person, either in the work or in the Profiled Person's personal life.

8.7. The Provider shall not be liable for any decisions made by the Customer or any other person in accordance with the outcome of the Questionnaire.

8.8. The Provider shall take measures by available hardware and software means to ensure the operation of the Platform and availability of the stored Customer’s data, considering, in particular, the nature, scope, context and purposes of data processing, implementation costs, as well as how likely and serious the risks are.

8.9. The Provider reserves the right to refuse to register or create a Customer Subscription, even without giving reasons.

8.10. The Provider stores and further analyzes anonymous and anonymized data to which it has access in connection with the operation of the Platform. This data is not linked to or identify any Customer, Profiled Person, or other person in the provision of the Platform's services, either physically or with a legal entity.

8.11. The Provider undertakes to hold the data in the Subscription for a maximum of one year from the date of the last one-off payment; subsequently, all data in the Subscription may be deleted; the retention period of some other data may be different (logos for two years, etc.) . In the event that no payment is made, the Provider holds data within the Subscription for a maximum of one year from the date of establishment of the Subscription.

9. CUSTOMER RIGHTS AND OBLIGATIONS

9.1. The Customer agrees that the Contract is concluded in a distance manner through distance communication.

9.2. Customer has the right to terminate the Agreement at any time without giving reasons, by terminating the Subscription by clicking on the "Cancel Subscription" button in the "Settings\Management\Cancellation" section. The Customer acknowledges that by terminating the Subscription, he/she will lose all stored results and purchased paid Questionnaires or other products, without any right to compensation.

9.3. Furthermore, the Customer is entitled to withdraw from the Contract within 14 days of its conclusion without giving reasons, by delivery of the withdrawal (by registered mail) from the Contract to the Provider (for withdrawal it is possible to use the model form, which is Annex No. 1 of these GTC to the address indicated there).

9.4. If a performance has already been provided within the period referred to in the previous paragraph, the Customer is not entitled to reimbursement of the paid proportional part of the Price for services drawn before withdrawal from the Contract and to pay the Provider.

9.5. The Customer, the User in any capacity and the Profiled Person undertake to maintain confidentiality about the content and structure of the Questionnaires, functionality and know-how of the Platform and will not disclose or otherwise disclose this information directly or indirectly under any circumstances or otherwise to third parties without the Prior Written Consent of the Provider; otherwise, it will reimburse the Provider or third parties for the damage caused by it.

9.6. The Customer, the User in any capacity and the Profiled Person undertake not to disseminate, store, copy, modify or further process the content of the Questionnaires or the Platform interface. The Customer is aware that the content of the Platform, including texts and Questionnaires, design, graphics, image, and arrangement of files, is protected by copyright.

9.7. Article 9.5 and 9.6. of these GTC is without prejudice to the Customer's right to forward the results of questionnaires to a third party or to share these results with a third party, with which the Profiled Person must give his consent.

9.8. Both the Customer and the Client must ensure that their account login details are not misused and are obliged to protect them, as well as to use sufficiently secure passwords.

9.9. The Customer is entitled to exercise the rights from defective performance in writing with the Provider at the address of his registered office or at the e-mail address support@talk2amy.com.

9.10. The Customer undertakes to use the Platform and all services according to these GTC for personal use, not for commercial use.

10. RIGHTS FROM DEFECTIVE PERFORMANCE

10.1. In particular, the following shall be considered as defective performance:

• Annual average system availability below 95%
• Repetitive (at least twice in one calendar week) with error states on key functions of the system, which are:
(i) User login
(ii) Manage Users
(iii) Administration and execution of tests
(iv) Visualization of test results
(v) Subscription administration

10.2. The Customer is obliged to inform the Provider about defective performance and to assert and prove the claim from defective performance without undue delay, no later than 6 months after the provision of the defective subject of performance from the Contract. If the Customer does not make a notification, does not make and does not establish a claim for defective performance within the specified period, this claim shall lapse.

10.3. Rights from defective performance are exercised in writing at e-mail support@talk2amy.com or at Mongata s.r.o., ID: 089 60 585, with registered office at Plynární 1617/10, Prague 7, zip code 170 00.

10.4. The Provider is obliged to comment on the exercise of rights from defective performance no later than 30 (thirty) days from the date of application. This period is extended by the period during which documents necessary for the processing of his rights from defective performance have not been supplied to the Provider by the Provider and the period during which it is necessary to obtain comments from third parties, in particular experts, law enforcement authorities or other state authorities or institutions.

10.5. Unavailability or malfunction or limited functionality of the Platform is not considered defective if the Customer does not meet the minimum conditions for its functionality within the meaning of paragraph 3.8. of these GTC.

11. OUT-OF-COURT DISPUTE RESOLUTION

11.1. The Czech Trade Inspection Authority is responsible for the out-of-court settlement of disputes under the Consumer Agreements, with its registered office at Štěpánská 567/15, 120 00 Prague 2, ID: 00020869, internet address: www.coi.cz.

11.2. The online dispute resolution platform located at http://ec.europa.eu/consumers/odr can be used to resolve disputes with a Client who is a consumer, is residing in another Member State of the European Union and a Provider from the Contracts.

11.3. European Consumer Centre Czech Republic, established in Štěpánská 567/15, 120 00 Prague 2, internet address: www.evropskyspotrebitel.cz is the contact point for resolving online disputes within the meaning of Regulation No 524/2013 of the European Parliament and of the Council (EU) of 21 May 2013 on the settlement of consumer disputes online, and performs functions within the meaning of this legislation only if the parties to the dispute are not habitually resident (established) in the same member state of the European Union.

12. COLLISION ADJUSTMENT

12.1. The Contracts are governed by the law of the Czech Republic.

12.2. If the Client is a consumer habitually resident in a state that is party to Regulation No 593/2008 of the European Parliament and of the Council (EC) on the law applicable to contractual obligations (Rome Regulation I.), the laws of the state in which the consumer is habitually resident and from which the contractual obligations cannot deviate, shall prevail over the legal order of the Czech Republic.

12.3. All disputes arising from the Contracts will be settled by the courts whose jurisdiction is governed by Article 17 and subsequent Regulation (EU) No 1215/2012 of the European Parliament and of the Council (EU), on jurisdiction and recognition and enforcement of judgments in civil and commercial matters.

13. FINAL PROVISIONS

13.1. If any provision of these GTC would be contrary to the mandatory provisions of the Czech Republic of applicable and effective legislation or international standards, then the provisions of these regulations and standards will apply, but this does not affect the validity of the other arrangements of these GTC or the validity of these GTC as a whole.

13.2. The Contracting Parties expressly declare that the provisions of these GTC, which are different from those of the Civil Code or other legislation, are thus agreed knowingly by way of derogation and at the same time declare that these derogations are not contrary to good morals, do not violate public policy or the law concerning the status of persons, including the right to the protection of personality, and are agreed honestly.

13.3. These GTC are effective from the date November 1st, 2021.

ANNEX 1

Sample withdrawal form

Sender:
First and last name:
Residence:
(or e-mail, phone number):
(hereinafter referred to as "Customer")

Addressee:
Mongata s.r.o.
ID(IČO): 089 60 585
established: Plynární 1617/10, Prague 7, zip 170 00
(hereinafter referred to as "Provider")

Notice of Withdrawal from the Contract

Customer hereby withdraws from the service contract concluded between the Customer and the Provider on the specified 14-day period, dated ____________________.

At ____________________ on ____________________

Customer First and Last Name

(signature)