General terms and conditions
General Terms and Conditions ThuiswinkelThese General Terms and Conditions of the Dutch Thuiswinkel Organization (hereinafter: Thuiswinkel.org) were drawn up in consultation with the Consumers' Association in the context of the Coordination Group Self-Regulation Consultation (CZ) of the Social-Economic Council and come into effect on 1 June 2014. < br>
Table of contents:
Article 1 – Definitions
Article 2 – Identity of the entrepreneur
Article 3 – Applicability
Article 4 – The offer
Article 5 – The agreement
Article 6 - Right of withdrawal
Article 7 - Obligations of the consumer during the cooling-off period
Article 8 - Exercise of the right of withdrawal by the consumer and costs thereof
Article 9 - Obligations of the entrepreneur in the event of withdrawal
Article 10 – Exclusion of right of withdrawal
Article 11 – The price
Article 12 – Compliance and additional warranty
Article 13 – Delivery and execution
Article 14 – Duration transactions: duration, cancellation and extension
Article 15 – Payment
Article 16 - Complaints procedure
Article 17 - Disputes
Article 18 - Industry guarantee
Article 19 - Additional or deviating provisions
Article 20 - Changes to the General Terms and Conditions of Thuiswinkel
Article 1 – DefinitionsIn these conditions the following definitions apply:
1. Additional agreement: an agreement whereby the consumer acquires products, digital content and/or services in connection with a distance contract and these goods, digital content and/or services are supplied by are delivered to the entrepreneur or by a third party on the basis of an agreement between that third party and the entrepreneur;
2. Reflection period: the period within which the consumer can exercise his right of withdrawal;
3. Consumer: the natural person who is not acting for purposes related to his trade, business, craft or professional activity;
4. Day: calendar day;
5. Digital content: data that is produced and delivered in digital form;
6. Duration agreement: an agreement that extends to the regular delivery of goods, services and/or digital content for a certain period;
7. Durable data carrier: any tool - including e-mail - that enables the consumer or entrepreneur to store information that is personally addressed to him in a way that allows future consultation or use for a period that is tailored to the purpose for which the information is intended, and that allows unchanged reproduction of the stored information;
8. Right of withdrawal: the option of the consumer to withdraw from the agreement within the cooling-off period remotely;
9. Entrepreneur: the natural or legal person who is a member of Thuiswinkel.org and offers products, (access to) digital content and/or services remotely to consumers;
10. Distance contract: a agreement concluded between the entrepreneur and the consumer in the context of an organized system for distance selling of products, digital content and/or services, whereby up to and including the conclusion of the agreement, exclusive or joint use is made of one or more techniques for distance communication;
11. Model withdrawal form: the European model withdrawal form included in Appendix I of these conditions; Appendix I does not have to be made available if the consumer does not have the right of withdrawal with regard to his order;
12. Technology for distance communication: means that can be used to conclude an agreement, without the consumer and entrepreneur simultaneously need not have met in the same room.
Article 2 – Identity of the entrepreneurName of entrepreneur: White Cloudz B.V.
Trading under the name(s):
– White Cloudz B.V.
1017 EK Amsterdam
Phone number: 085-060 2251
From Monday to Friday from 9:30 AM to 5:30 PM
From Saturday to Saturday from 10:00 AM to 2:00 PM
Email address: firstname.lastname@example.org
Chamber of Commerce number: 67992633
VAT number: NL857257043B01
Article 3 – Applicability1. These general terms and conditions apply to every offer from the entrepreneur and to every distance contract concluded between the entrepreneur and the consumer.
2. Before the distance contract is concluded, the text of these general terms and conditions is provided to the made available to consumers. If this is not reasonably possible, the entrepreneur will indicate before the distance contract is concluded how the general terms and conditions can be viewed at the entrepreneur and that they will be sent free of charge as soon as possible at the request of the consumer.
3. If the distance contract is concluded electronically, notwithstanding the previous paragraph and before the distance contract is concluded, the text of these general terms and conditions can be made available to the consumer electronically in such a way that it can be read by the consumer. consumer can be easily stored on a durable data carrier. If this is not reasonably possible, before the distance contract is concluded, it will be indicated where the general terms and conditions can be viewed electronically and that they will be sent free of charge electronically or otherwise at the request of the consumer. br> 4. In the event that, in addition to these general terms and conditions, specific product or service terms and conditions also apply, the second and third paragraphs apply mutatis mutandis and in the event of conflicting terms and conditions, the consumer can always rely on the applicable provision that applies to him. is the most favorable.
Article 4 – The offer1. If an offer has a limited period of validity or is made subject to conditions, this will be expressly stated in the offer.
2. The offer contains a complete and accurate description of the products, digital content and/or services offered. The description is sufficiently detailed to enable a good assessment of the offer by the consumer. If the entrepreneur uses images, these are a true representation of the products, services and/or digital content offered. Obvious mistakes or errors in the offer do not bind the entrepreneur.
3. Each offer contains such information that it is clear to the consumer what the rights and obligations are associated with acceptance of the offer.
Article 5 – The Agreement1. The agreement is concluded, subject to the provisions of paragraph 4, at the moment of acceptance by the consumer of the offer and compliance with the conditions set.
2. If the consumer accepts the offer electronically has accepted, the entrepreneur will immediately confirm receipt of the acceptance of the offer electronically. As long as receipt of this acceptance has not been confirmed by the entrepreneur, the consumer can terminate the agreement.
3. If the agreement is concluded electronically, the entrepreneur will take appropriate technical and organizational measures to secure the electronic transfer of data and he ensures a safe web environment. If the consumer can pay electronically, the entrepreneur will take appropriate security measures.
4. The entrepreneur can, within legal frameworks, inform himself whether the consumer can meet his payment obligations, as well as all those facts and factors. that are important for a responsible conclusion of the distance contract. If, on the basis of this investigation, the entrepreneur has good reasons not to enter into the agreement, he is entitled to refuse an order or request with reasons or to attach special conditions to the execution.
5. The entrepreneur will, at the latest upon delivery of the product, service or digital content to the consumer, send the following information, in writing or in such a way that it can be stored by the consumer in an accessible manner on a durable data carrier:
a. the visiting address of the establishment of the entrepreneur where the consumer can go with complaints;
b. the conditions under which and the manner in which the consumer can exercise the right of withdrawal, or a clear statement regarding the exclusion of the right of withdrawal;
c. the information about warranties and existing after-sales service;
d. the price including all taxes of the product, service or digital content; where applicable, the costs of delivery; and the method of payment, delivery or execution of the distance contract;
e. the requirements for termination of the agreement if the agreement has a duration of more than one year or is of indefinite duration;
f. if the consumer has a right of withdrawal, the model withdrawal form.
6. In the case of a duration transaction, the provision in the previous paragraph only applies to the first delivery.
Article 6 – Right of withdrawalFor products:
1. The consumer can terminate an agreement regarding the purchase of a product during a cooling-off period of 30 days without giving reasons. The entrepreneur may ask the consumer about the reason for withdrawal, but may not oblige him to state his reason(s).
2. The reflection period referred to in paragraph 1 commences on the day after the consumer, or a prior agreement by the consumer's designated third party, who is not the carrier, has received the product, or:
a. if the consumer has ordered multiple products in the same order: the day on which the consumer, or a third party designated by him, receives the received the last product. The entrepreneur may, provided he has clearly informed the consumer of this prior to the ordering process, refuse an order for multiple products with different delivery times.
b. if the delivery of a product consists of different shipments or parts: the day on which the consumer, or a third party designated by him, has received the last shipment or part;
c. in the case of agreements for regular delivery of products during a certain period: the day on which the consumer, or a third party designated by him, received the first product.
For services and digital content that is not delivered on a tangible medium:
3. The consumer can enter into a service agreement and an agreement for the supply of digital content that is not delivered on a tangible medium for a period of Cancel within 30 days without giving reasons. The entrepreneur may ask the consumer the reason for withdrawal, but may not oblige him to state his reason(s).
4. The reflection period referred to in paragraph 3 starts on the day following the conclusion of the agreement.
Extended reflection period for products, services and digital content that is not delivered on a tangible medium if no information is provided about the right of withdrawal:
5. If the entrepreneur provides the consumer with the legally required information about the right of withdrawal or the model form for withdrawal, the reflection period expires twelve months after the end of the original reflection period determined in accordance with the previous paragraphs of this article.
6. If the entrepreneur has provided the consumer with the information referred to in the previous paragraph within twelve months after the commencement date of the original reflection period, the reflection period expires 30 days after the day on which the consumer received that information.
Article 7 – Obligations of the consumer during the cooling-off period1. During the reflection period, the consumer will handle the product and packaging with care. He will only unpack or use the product to the extent necessary to determine the nature, characteristics and operation of the product. The basic principle here is that the consumer may only handle and inspect the product as he would in a store.
2. The consumer is only liable for depreciation of the product that is the result of a way of handling the product. product that goes further than permitted in paragraph 1.
3. The consumer is not liable for depreciation of the product if the entrepreneur has not provided him with all legally required information about the right of withdrawal before or at the time of concluding the agreement.
Article 8 – Exercise of the right of withdrawal by the consumer and costs thereof1. If the consumer exercises his right of withdrawal, he must report this to the entrepreneur within the cooling-off period using the model withdrawal form or in another unambiguous manner.
2. As soon as possible, but within 14 days from the day following on the notification referred to in paragraph 1, the consumer returns the product or hands it over to (an authorized representative of) the entrepreneur. This is not necessary if the entrepreneur has offered to collect the product himself. The consumer has in any case observed the return period if he returns the product before the cooling-off period has expired.
3. The consumer returns the product with all accessories supplied, if reasonably possible in the original condition and packaging, and in accordance with the reasonable and clear instructions provided by the entrepreneur.
4. The risk and burden of proof for the correct and timely exercise of the right of withdrawal lies with the consumer.
5. The consumer bears the direct costs of returning the product . If the entrepreneur has not stated that the consumer must bear these costs or if the entrepreneur indicates that he will bear the costs himself, the consumer does not have to bear the costs for return.
6. If the consumer withdraws after having first expressly requested that the performance of the service or the supply of gas, water or electricity that is not prepared for sale in a limited volume or specific quantity commences during the cooling-off period, the consumer owes the entrepreneur an amount that is proportional to that part of the obligation that has been fulfilled by the entrepreneur at the time of withdrawal, compared to the full fulfillment of the obligation.
7. The consumer does not bear any costs for the performance of services or the supply of water, gas or electricity that is not ready are made for sale in a limited volume or quantity, or for the supply of district heating, if:
a. the entrepreneur has not provided the consumer with the legally required information about the right of withdrawal, the cost reimbursement in the event of withdrawal or the model form for withdrawal provided, or;
b. the consumer has not expressly requested the start of the performance of the service or delivery of gas, water, electricity or district heating during the cooling-off period.
8. The consumer shall not bear any costs for the full or partial delivery of digital content not delivered on a tangible medium, if:
a. he has not expressly agreed to this prior to its delivery commencing performance of the agreement before the end of the cooling-off period;
b. he has not acknowledged that he loses his right of withdrawal when granting his consent; or
c. the entrepreneur has failed to confirm this statement from the consumer.
9. If the consumer exercises his right of withdrawal, all additional agreements will be dissolved by operation of law.
Article 9 – Obligations of the entrepreneur in the event of withdrawal1. If the entrepreneur makes the notification of withdrawal by the consumer possible electronically, he will immediately send a confirmation of receipt after receiving this notification.
2. The entrepreneur will reimburse all payments made by the consumer, including any delivery costs made by the entrepreneur in will be charged for the returned product, without delay but within 14 days following the day on which the consumer notifies him of the withdrawal. Unless the entrepreneur offers to collect the product himself, he may wait to pay back until he has received the product or until the consumer demonstrates that he has returned the product, whichever is the earlier.
3. The entrepreneur uses for reimbursement the same payment method that the consumer used, unless the consumer agrees to another method. The refund is free of charge for the consumer.
4. If the consumer has opted for a more expensive method of delivery than the cheapest standard delivery, the entrepreneur does not have to reimburse the additional costs for the more expensive method.
Article 10 – Exclusion of right of withdrawalThe entrepreneur can exclude the following products and services from the right of withdrawal, but only if the entrepreneur has clearly stated this in the offer, at least in time before concluding the agreement:
1. Products or services whose price is subject to fluctuations in the financial market over which the entrepreneur has no influence and which may occur within the withdrawal period
2. Agreements concluded during a public auction. A public auction is defined as a sales method in which products, digital content and/or services are offered by the entrepreneur to the consumer who is personally present or has the opportunity to be personally present at the auction, under the supervision of an auctioneer, and where the successful bidder is obliged to purchase the products, digital content and/or services;
3. Service agreements, after full performance of the service, but only if:
a. the performance has started with express prior consumer consent; and
b. the consumer has stated that he loses his right of withdrawal as soon as the entrepreneur has fully executed the agreement;
4. Package trips as referred to in Article 7:500 of the Dutch Civil Code and passenger transport contracts;
5. Service agreements for the provision of accommodation, if the agreement provides for a specific date or period of performance and other than for residential purposes, freight transport, car rental services and catering;
6. Agreements relating to leisure activities, if in the the agreement provides for a specific date or period of performance;
7. Products manufactured according to the consumer's specifications, which are not prefabricated and which are manufactured on the basis of an individual choice or decision of the consumer, or which are clearly intended for a intended for a specific person;
8. Products that spoil quickly or have a limited shelf life;
9. Sealed products that are not suitable for return for reasons of health protection or hygiene and of which the seal has been broken after delivery;
10. Products that, by their nature, are irrevocably mixed with other products after delivery;
11. Alcoholic drinks the price of which was agreed upon at the conclusion of the agreement, but delivery of which can only take place after 30 days, and the actual value of which depends on market fluctuations over which the entrepreneur has no influence;
12. Sealed audio, video recordings and computer software, of which the seal has been broken after delivery;
13. Newspapers, magazines or magazines, with the exception of subscriptions thereto;
14. The delivery of digital content other than on a tangible medium, but only if:
a. the performance has started with the express prior consent of the consumer; and
b. the consumer has stated that he thereby loses his right of withdrawal.
Article 11 – The price1. During the period of validity stated in the offer, the prices of the products and/or services offered will not be increased, except for price changes as a result of changes in VAT rates.
2. Notwithstanding the previous paragraph, the entrepreneur can offering services at variable prices, the prices of which are subject to fluctuations in the financial market and over which the entrepreneur has no influence. This liability to fluctuations and the fact that any stated prices are target prices are stated in the offer.
3. Price increases within 3 months after the conclusion of the agreement are only permitted if they are the result of legal regulations or provisions.
br> 4. Price increases from 3 months after the conclusion of the agreement are only permitted if the entrepreneur has stipulated this and:
a. these are the result of legal regulations or provisions; or
b. the consumer has the authority to terminate the agreement with effect from the day on which the price increase takes effect.
5. The prices stated in the offer of products or services include VAT.
Article 12 – Compliance with the agreement and additional warranty1. The entrepreneur guarantees that the products and/or services comply with the agreement, the specifications stated in the offer, the reasonable requirements of reliability and/or usability and the legal requirements existing on the date of the conclusion of the agreement. provisions and/or government regulations. If agreed, the entrepreneur also guarantees that the product is suitable for other than normal use.
2. An additional warranty provided by the entrepreneur, his supplier, manufacturer or importer never limits the legal rights and claims that the consumer has on under the agreement against the entrepreneur if the entrepreneur has failed to fulfill his part of the agreement.
3. Additional warranty means any obligation of the entrepreneur, his supplier, importer or producer in which he grants the consumer certain rights or claims that go beyond what he is legally obliged to do if he has failed to fulfill his part of the agreement.
Article 13 – Delivery and execution1. The entrepreneur will exercise the greatest possible care when receiving and executing orders for products and when assessing requests for the provision of services.
2. The place of delivery is the address provided by the consumer has made known to the entrepreneur.
3. Taking into account what is stated in Article 4 of these general terms and conditions, the entrepreneur will execute accepted orders expeditiously, but no later than within 30 days, unless a different delivery period has been agreed. If delivery is delayed, or if an order cannot be fulfilled or can only be partially fulfilled, the consumer will be notified of this no later than 30 days after he has placed the order. In that case, the consumer has the right to terminate the agreement without costs and the right to any compensation.
4. After termination in accordance with the previous paragraph, the entrepreneur will immediately refund the amount paid by the consumer.
5. The risk of damage and/or loss of products rests with the entrepreneur until the moment of delivery to the consumer or a representative designated in advance and made known to the entrepreneur, unless expressly agreed otherwise.
Article 14 – Duration transactions: duration, termination and extensionCancellation:
1. The consumer can cancel an agreement that has been entered into for an indefinite period and that extends to the regular delivery of products (including electricity) or services at any time, taking into account the agreed cancellation rules and a notice of termination. notice period of no more than one month.
2. The consumer can enter into an agreement that has been entered into for a definite period and which extends to the regular delivery of products (including electricity) or services, at any time towards the end of the fixed term. cancel with due observance of the agreed cancellation rules and a notice period of no more than one month.
3. The consumer can cancel the agreements referred to in the previous paragraphs:
a. at any time and not be limited to cancellation at a certain time or in a certain period;
b. at least cancel in the same manner as they were entered into by him;
c. always cancel with the same notice period as the entrepreneur has agreed for himself.
4. An agreement entered into for a definite period and which extends to the regular delivery of products (including electricity) or services may not be tacitly be extended or renewed for a specific period.
5. Notwithstanding the previous paragraph, an agreement entered into for a fixed period and which extends to the regular delivery of daily newspapers and weeklies and magazines may be tacitly extended for a period of fixed term of a maximum of three months, if the consumer can cancel this extended agreement towards the end of the extension with a notice period of no more than one month.
6. An agreement that has been entered into for a definite period and that extends to regular delivery of products or services, may only be tacitly extended for an indefinite period if the consumer may cancel at any time with a notice period of no more than one month. The notice period is a maximum of three months if the agreement extends to the regular, but less than once a month, delivery of daily, news and weekly newspapers and magazines.
7. An agreement with a limited duration to the regular introductory Delivery of daily, news and weekly newspapers and magazines (trial or introductory subscription) is not tacitly continued and ends automatically after the trial or introductory period.
8. If an agreement has a duration of more than one year, the consumer may terminate the agreement at any time after one year with a notice period of no more than one month, unless reasonableness and fairness oppose termination before the end of the agreed duration.
Article 15 – Payment1. Unless otherwise stated in the agreement or additional conditions, the amounts owed by the consumer must be paid within 14 days after the start of the reflection period, or in the absence of a reflection period, within 14 days after the conclusion of the agreement. agreement. In the case of an agreement to provide a service, this period commences on the day after the consumer has received confirmation of the agreement.
2. When selling products to consumers, the consumer may never be obliged in general terms and conditions be required to pay more than 50% in advance. If advance payment has been stipulated, the consumer cannot assert any rights regarding the execution of the relevant order or service(s) before the stipulated advance payment has been made.
3. The consumer has the obligation to report inaccuracies in the payment details provided or stated. to report this to the entrepreneur immediately.
4. If the consumer does not fulfill his payment obligation(s) on time, after the entrepreneur has informed him of the late payment and the entrepreneur has given the consumer a period of 14 days to still meet its payment obligations, after failure to pay within this 14-day period, the entrepreneur will owe statutory interest on the amount still owed and the entrepreneur is entitled to charge the extrajudicial collection costs incurred by him. These collection costs amount to a maximum of: 15% on outstanding amounts up to € 2,500; 10% on the next € 2,500 and 5% on the next € 5,000 with a minimum of € 40. The entrepreneur may deviate from the stated amounts and percentages for the benefit of the consumer.
Article 16 – Complaints procedure1. The entrepreneur has a sufficiently publicized complaints procedure and handles the complaint in accordance with this complaints procedure.
2. Complaints about the execution of the agreement must be submitted fully and clearly described within a reasonable time after the consumer has discovered the defects. the entrepreneur.
3. Complaints submitted to the entrepreneur will be answered within a period of 14 days from the date of receipt. If a complaint requires a foreseeably longer processing time, the entrepreneur will respond within 14 days with an acknowledgment of receipt and an indication when the consumer can expect a more detailed answer.
4. A complaint about a product or service or the service of the entrepreneur can also be submitted via a complaints form on the consumer page of the Thuiswinkel.org website www.thuiswinkel.org. The complaint will then be sent to both the entrepreneur in question and to Thuiswinkel.org.
5. The consumer must give the entrepreneur at least 4 weeks to resolve the complaint by mutual agreement. After this period, a dispute arises that is subject to the dispute settlement procedure.
Article 17 – Disputes1. Agreements between the entrepreneur and the consumer to which these general terms and conditions apply are exclusively governed by Dutch law.
2. Disputes between the consumer and the entrepreneur regarding the conclusion or execution of agreements with regard to products and services delivered or delivered, can, subject to the provisions below, be submitted by both the consumer and the entrepreneur to the Thuiswinkel Disputes Committee, PO Box 90600, 2509 LP in The Hague (www.sgc.nl).
3 A dispute will only be dealt with by the Disputes Committee if the consumer has first submitted his complaint to the entrepreneur within a reasonable time.
4. If the complaint does not lead to a solution, the dispute must be filed no later than 12 months after the date on which the consumer submitted the complaint to the entrepreneur, will be submitted to the Disputes Committee in writing or in another form to be determined by the Commission.
5. If the consumer wishes to submit a dispute to the Disputes Committee, the entrepreneur is bound to this choice . The consumer preferably reports this to the entrepreneur first. 6. If the entrepreneur wishes to submit a dispute to the Disputes Committee, the consumer must express in writing within five weeks of a written request made by the entrepreneur whether he wishes this or whether he wants the dispute to be handled by the competent person. right. If the entrepreneur does not learn of the consumer's choice within the period of five weeks, the entrepreneur is entitled to submit the dispute to the competent court.
7. The Disputes Committee makes its decision under the conditions as laid down in the regulations of the Disputes Committee (www.degeschilcommissie.nl/over-ons/de-commissies/2404/thuiswinkel). The decisions of the Disputes Committee are made by way of binding advice.
8. The Disputes Committee will not handle a dispute or will discontinue the handling if the entrepreneur has been granted a suspension of payments, has become bankrupt or has actually ceased its business activities. has ended before a dispute has been dealt with by the committee at the hearing and a final decision has been made.
9. If, in addition to the Thuiswinkel Disputes Committee, another recognized or registered with the Stichting Disputes Committees for Consumer Affairs (SGC) or the Financial Services Complaints Institute (Kifid) ) affiliated disputes committee is competent, the Thuiswinkel Disputes Committee is preferably competent for disputes relating mainly to the method of distance sales or services. For all other disputes, the other recognized dispute committee affiliated with SGC or Kifid.
Article 18 – Industry Guarantee1. Thuiswinkel.org guarantees compliance with the binding advice of the Thuiswinkel Disputes Committee by its members, unless the member decides to submit the binding advice to the court for review within two months after it was sent. This guarantee is revived if the binding advice has been upheld after review by the court and the judgment demonstrating this has become final and final. Up to a maximum amount of €10,000 per binding advice, this amount will be paid out to the consumer by Thuiswinkel.org. For amounts greater than €10,000 per binding advice, €10,000 will be paid out. For the excess, Thuiswinkel.org has an obligation to ensure that the member complies with the binding advice.
2. To apply this guarantee, the consumer is required to make a written appeal to Thuiswinkel.org and to submit his claim. on the entrepreneur to Thuiswinkel.org. If the claim against the entrepreneur amounts to more than €10,000, the consumer is offered to transfer his claim insofar as it exceeds the amount of €10,000 to Thuiswinkel.org, after which this organization will make the payment in its own name and at its own expense. will legally demand this in order to satisfy the consumer.
Article 19 – Additional or deviating provisionsAdditional or deviating provisions from these general terms and conditions may not be to the detriment of the consumer and must be recorded in writing or in such a way that they can be stored by the consumer in an accessible manner on a durable data carrier.
Article 20 – Changes to the General Terms and Conditions of Home Shopping1. Thuiswinkel.org will not change these general terms and conditions except in consultation with the Consumers' Association. During the term of an offer, the most favorable provision for the consumer will prevail.
Horaplantsoen 20, 6717 LT Ede
PO Box 7001, 6710 CB Ede
Appendix I: Model withdrawal form
Model withdrawal form
(only complete and return this form if you want to withdraw from the agreement)
a. To: [name of entrepreneur]
[geographical address of entrepreneur ]
[ entrepreneur's fax number, if available]
[ e-mail address or electronic address of entrepreneur]
b. I/We* hereby inform you that I/we* have terminated our agreement regarding
the sale of the following products: [product designation]*
the supply of the following digital content: [digital content designation ]*
the performance of the following service: [service designation]*, revoked/revoked*
c. Ordered on*/received on* [date of order for services or receipt of products]
d. [Name of consumer(s)]
e. [Consumer(s) address]
f. [Signature of consumer(s)] (only when this form is submitted on paper)
* Delete as appropriate or fill in as appropriate.