Terms and Conditions

Effective Date: 06/12/2020

1. Introduction

1.1 We are Childcare Limited trading as "Childcare.co.uk". Our company information is at the end of this document.

2. Definitions

2.1 Capitalised terms have the following meanings in these terms and conditions:

a) “App” – the Childcare.co.uk mobile application.

b) “Appstore” – the app distributor from which you download the App.

c) “Appstore Rules” – any applicable rules, policies or terms of the relevant Appstore.

d) “Childcare Contract” – a contract for the supply of Childcare Services between a Childcare Provider and a Parent.

e) “Childcare Provider” – a User who uses our Service for the purpose of providing childcare services to Parents.

f) “Childcare Services” – childcare services such as babysitting, childminding, nannying, nurseries, private tutoring, midwifery or maternity nursing.

g) “Consumer” – an individual acting for purposes which are wholly or mainly outside that person’s trade, business, craft or profession.

h) “Content” – all information of whatever kind (including profiles, reviews, posts, comments, documents, audio, video, advertisements, messages) uploaded to our Service (including messages sent via our Service).

i) “Parent” – a parent or guardian who uses our Service for the purpose of availing of Childcare Services.

j) “Service” – our website, our App and any related services.

k) “User” – persons or organisations using our Service (whether or not registered with us).

3. Applicability of terms and conditions

3.1 Please read these terms and conditions carefully. They replace any previous versions. By registering on or using our Service you you enter a contract with us on the basis of these these terms and conditions. Alternatively, if you first download our App, you enter into a legal contract with us at that point. Please print or save these terms for future use as we will not keep a file copy specifically for the transaction with you and we cannot guarantee that they will remain accessible on our Service in future. These terms and conditions are available in English only.

3.2 These terms and conditions apply to all Users.

3.3 For App users: These terms and conditions are an “end user licence agreement” between you and us (not the Appstore) in relation to our App (i.e. setting out how we allow you to use our App) and, in addition, you agree to be legally bound by the Appstore Rules.

4. Changes to the terms and conditions

4.1 We may change these terms and conditions by giving you at least 15 days' notice unless a more urgent change is needed to comply with laws or regulations or to deal with an unforeseen and imminent danger. We will notify you by posting the new version on our website and by giving notice by email, SMS and/or in-app message.

4.2 If you don’t agree to the new terms, you can end this contract with effect from 15 days after our notice by emailing us within that period.

5. Right to cancel (“cooling off”)

5.1 If you are a Consumer, you have the right to cancel this contract subject to the provisions set out below.

5.2 If you do have the right to cancel, the following apply:

Right to cancel

5.3 You have the right to cancel this contract within 14 days without giving any reason.

5.4 The cancellation period will expire after 14 days from the day of the conclusion of the contract.

5.5 To exercise the right to cancel, you must inform us Childcare Limited, 1 High Street Mews, Wimbledon Village, London, SW19 7RG or via email to support@childcare.co.uk of your decision to cancel this contract by a clear statement (e.g. a letter sent by post or e-mail). You may use the model cancellation form at the end of this document but it is not obligatory.

5.6 To meet the cancellation deadline, it is sufficient for you to send your communication concerning your exercise of the right to cancel before the cancellation period has expired.

Effects of cancellation

5.7 If you cancel this contract, we will reimburse to you all payments received from you.

5.8 We will make the reimbursement without undue delay, and not later than 14 days after the day on which we are informed about your decision to cancel this contract.

5.9 We will make the reimbursement using the same means of payment as you used for the initial transaction, unless you have expressly agreed otherwise; in any event, you will not incur any fees as a result of the reimbursement.

5.10 If you requested us to begin the performance of services during the cancellation period, you shall pay us an amount which is in proportion to what has been performed until you have communicated to us your cancellation of this contract in comparison with the full coverage of the contract.

6. Your right to use our Service

6.1 We grant you a limited personal non-transferable right to use our Service on any applicable device owned or controlled by you (only Apple-branded where Apple Inc is the App Store) subject to these terms and conditions and, where applicable, in accordance with the Appstore Rules.

7. Who can use our Service?

7.1 You must not use, or attempt to register on, our Service if:

a) you are resident or if a company, incorporated, outside the UK;

b) you are below 18 years of age; or

c) you have been convicted of any offence, or subject to any court order, relating to assault, violence, sexual misconduct, harassment or dishonesty.

7.2 Our Service is designed for, and may only be used by, persons who genuinely intend to use the Service to provide or avail of Childcare Services.

7.3 You must not use, or attempt to register on, our Service if you act as an agency or other intermediary for any Childcare Services.

8. Acceptable use of our Service

8.1 You agree that you will not in connection with the Service:

a) breach any applicable law, regulation or code of conduct;

b) upload any Content (including links or references to other content), or otherwise behave in a manner, which:

  • is defamatory, threatening, harassing, invasive of privacy, offensive, vulgar, racist, hateful, discriminatory, obscene, pornographic, sexually suggestive, promoting of self-harm, misleading, abusive or deceptive;
  • infringes any intellectual property or other rights of others;
  • involves phishing or scamming or similar; or
  • we otherwise reasonably consider to be inappropriate;

c) upload any Content which includes someone else’s personal information unless that person is 18 years or over and you have obtained that person’s explicit written consent or you are the parent/guardian of such person;

d) make recordings or screenshots of audio / video interactions without the written consent of all other participants;

e) impersonate any person or entity in order to mislead others;

f) upload any Content which links to any third party websites which are unlawful or contain inappropriate Content;

g) sell access to the Service;

h) use the Service to provide a similar service to third parties or otherwise with a view to competing with us;

i) sell advertising, sponsorship or promotions on or in connection with Content except where explicitly authorised by us;

j) use the Service for junk mail, spam, pyramid or similar or fraudulent schemes;

k) do anything which may have the effect of disrupting the Service including worms, viruses, software bombs or mass mailings;

l) do anything which may negatively affect other Users’ enjoyment of the Service;

m) gain unauthorised access to any part of the Service or equipment used to provide the Service;

n) intercept or modify communications to or from the Service;

o) deliberately exploit any bugs found with the Service;

p) circumvent any security or other features of the Service including features that restrict use or copying of Content;

q) use any automated means to interact with our systems excluding public search engines; or

r) attempt, encourage or assist any of the above.

8.2 You must comply with any rules or requirements on our website.

8.3 You must promptly comply with any reasonable request or instruction by us in connection with the Service.

8.4 You must ensure that any contact or other information which you supply to us is accurate and not misleading and you will update it so that it remains so.

9. Your Content (e.g. profiles, reviews and messages)

9.1 You are responsible for your Content.

9.2 You promise to us that you have (and will retain) all rights and permissions needed to enable use of your Content as contemplated by the Service and these terms and conditions.

9.3 If you post a review, you promise that you have no personal or business relationship with the entity, product or service being reviewed, that you are not a competitor of that entity, that you have not been offered any incentive to write the review and that the review is your independent, honest, genuine opinion.

9.4 If you use any features on our site which enable you to share your Content with third party sites, we are not responsible for use of your Content on those third party sites. You acknowledge that we may share data from profiles with job search websites such as Google Jobs.

9.5 We reserve the right without notice or refund to reject, suspend, alter, remove or delete Content or to disclose to the police or other relevant authorities or to a complainant any Content or behaviour if it is the subject of complaint or where we have reason to believe that it breaches our terms and conditions, or that such steps are necessary to protect us or others, or that a criminal offence may have been committed, or where required by law or where requested by the police or other appropriate authorities or if we consider that Content does not meet our quality standards. If so, you must not attempt to re-publish or re-send the relevant Content.

9.6 It is your responsibility to decide which Content to upload (subject to these terms and conditions). We do not accept responsibility if your Content is misused by others as this is outside our reasonable control. Do not upload any Content if you are concerned that it may be misused.

9.7 We reserve the right in our discretion without notice to edit the text or layout of any profile or other Content uploaded to our Service to ensure it complies with our terms and conditions and otherwise in accordance with how we think your presence should appear on our Service.

9.8 We rank profiles in the search results in a choice of ways set by the User, including, nearest, newest, most recent login, top rated. The relevance of results is determined by a combination of factors, including last login, distance, number and rating of reviews and number of uploaded documents or as otherwise explained on our Service. Gold members are randomly featured at the top of the search results.

9.9 We do not guarantee that any profile or other Content will generate any particular level of revenues or suitable enquiries.

9.10 We reserve the right to place advertisements adjacent to or within your Content. We retain all revenue from such advertisements.

9.11 It is your responsibility to make your own frequent backups of Content to protect you in case of loss or damage to such material. We are not responsible for such loss or damage.

9.12 We may irretrievably delete your Content without telling you after this agreement ends or if your account has been inactive for twelve months.

9.13 Uninstalling the App may result in deletion of all Content on from your device.

10. Childcare Services (very important - we only provide a platform)

10.1 Our Service constitutes a neutral platform whereby Childcare Providers can arrange to supply Childcare Services to Parents. Any Childcare Contract is between the respective Childcare Provider and Parent and the terms are for the parties to agree. We are not a party to the Childcare Contract itself. You acknowledge that any legal recourse arising from breach of the Childcare Contract is against the other party to the Childcare Contract and not against us.

10.2 If you are a Childcare Provider, you promise us that in connection with supply of the Childcare Services to Parents:

a) You have the necessary abilities (including registrations, permissions, qualifications, skills, training, expertise).

b) You will act in accordance with the highest standards reasonably to be expected in the relevant industry.

c) You will comply with all applicable laws and regulations and will not infringe any third party rights.

10.3 Users agree to deal with other Users in a polite and courteous manner and to respond promptly to communications from other Users.

10.4 All Users promise us that they will only use any personal information of other Users strictly in accordance with applicable data protection laws and regulations.

10.5 If you have any complaint about another User, you must notify us promptly by email to support@childcare.co.uk. We may in our discretion try to resolve the dispute but we do not promise to get involved.

11. Dealing with other Users...

11.1 You accept that we have no obligation to vet or monitor Users or their Content. We do not endorse or recommend any Users. You rely on such information and/or deal with other Users at your own risk. We accept no legal responsibility for the accuracy of, or otherwise in relation to, any such Content or in connection with any dealings between Users. It is your responsibility to carry out careful and detailed investigations before dealing with other Users including use of or reliance on their Content. You should not assume that any Content from another User is accurate and be aware that a person may not be who he or she claims to be.

11.2 If we state on our Service that we hold a document such as a regulatory registration certificate or criminal records check, we do not guarantee that that any such document is accurate or valid or suitable for your purposes. If you are a Parent, it is your responsibility to seek access to the document via the relevant Childcare Provider and satisfy yourself including making additional enquiries where appropriate.

11.3 You acknowledge that in using the Service you may encounter behaviour or Content which you consider inappropriate. If so, please contact us at us at www.childcare.co.uk/contact (including if you wish to give us notice of defamatory material). Please also use any available blocking mechanisms, seek relevant external help If appropriate (e.g. from law enforcement authorities) and/or stop using the Service.

11.4 If you are a Childcare Provider, you acknowledge that we permit Parents to post reviews in relation to you and/or your services and that these will be publicly available for viewing and will remain so after this agreement ends. We are not responsible for monitoring or editing reviews. You acknowledge that such reviews may be critical or defamatory of you.

12. Other people’s services / advertising / websites

12.1 We may display other peoples’ services, advertising and links to other websites. These may include online training courses, insurance services, payroll services and discount schemes. We do not recommend or endorse, nor are we legally responsible for, those sites or services. You use them at your own risk.

13. Our guidance

13.1 We do not guarantee that guidance or other general information which we provide on our Service is accurate or up to date and we do not accept legal responsibility for it. Before acting on such information, you must make your own appropriate and careful enquiries including as to its accuracy and suitability for your purposes. The information is not intended as professional or other advice and is not tailored to your personal circumstances. Nor is it intended to be a substitute for possession of an appropriate level of training, qualifications, skill and experience in the matters covered. You rely on such information at your own risk.

14. Your account

14.1 Unless otherwise specifically stated on our Service, your account is for your personal use only and is non-transferable. You must not authorise or permit any other person to use your account. You must take reasonable care to protect and keep confidential your password and other account or identity information. You must notify us immediately of any apparent breach of security such as loss, theft, misuse or unauthorised disclosure or use of a password. You are responsible for third parties who use your account or identity (unless and to the extent that we are at fault).

15. Payment

15.1 While parts of our Service are available to Users free of charge, certain features are available only to Users who subscribe or (in the case of our App) pay the applicable one-off fee. Subscriptions can be acquired for the periods and by the payment methods specified on our Service. Payment is in advance. We reserve the right at any time to vary or remove any benefits applicable to subscribers.

15.2 The prices shown on our website include any applicable VAT unless we say otherwise.

15.3 If we have mis-priced any part of our Service, we are not obliged to supply the Service provided we notify you. If we do notify you, then you can decide if you want continue with the Service at the correct price but, if you do not, we will provide a full refund of any payments already made.

15.4 Where stated on our Service when you subscribed, your subscription will continue to be auto-renewed for the same subscription period which you signed up to unless you end your subscription before the renewal date by following the instructions on our Service. Ending your subscription does not entitle you to a refund (unless Consumer cooling off rights apply). You authorise us and our payment provider to charge your payment card for the relevant amounts when payments are due in accordance with this agreement.

15.5 We may at any time change our subscription prices. The new rate takes effect if you apply for a new subscription after we post the new prices on our Service. For existing subscribers, we will give you notice by email at least one month before any price change takes effect. If you do not accept the new fee, you should end your subscription by following the instructions on our Service. Otherwise the next renewal of your subscription after the one month’s notice will be at the new price.

15.6 You must contact us immediately with full details if you dispute any payment.

15.7 If any amount due to us is unpaid (including unjustifiable chargeback), without prejudice to any other remedy that may be available to us, we may charge you interest (both before and after judgment) on the amount unpaid at the rate for the time being that would be applicable if the debt were a qualifying debt under the Late Payment of Commercial Debts (Interest) Act 1998.

16. Discount codes

16.1 We may offer discount codes from time to time. Such codes may only be applied to purchases made through the account in respect of which the discount code was offered and registered and are not transferable or redeemable for cash. Unless otherwise stated: codes (1) are only available for future new orders placed online; (2) cannot be used retrospectively; (3) can only be redeemed once per customer; and (4) expire after 12 months. You cannot use more than one discount code per transaction unless we state otherwise; if we do so, the order in which the codes are to be applied is in our sole discretion.

16.2 We reserve the right to reject any discount code if we consider that it is being used in breach of these terms. Discount codes are subject to any additional specific terms and conditions which are specified at the point of issue. We reserve the right to discontinue or otherwise modify any discount codes at any time without prior notice.

17. Support

17.1 We do not supply support except to the extent specifically stated on our Service, as may be varied from time to time. You acknowledge that the Appstore has no obligation to supply any maintenance and support services in relation to the App.

18. Compatibility of App

18.1 We do not guarantee that the App is or will be compatible with any particular mobile devices or associated operating systems (OS’s). You must check that the App works on your applicable device before you subscribe. You acknowledge that the supplier of the device or OS may issue an update that causes our App to stop working. We may issue App updates through the Appstore; if so, you may not be able to use our App properly or at all until you have downloaded the update, which may be subject to the agreement of new terms and conditions. It is your responsibility to frequently monitor for App updates and to install them as soon as they become available.

19. Functioning of our Service

19.1 We do not guarantee that the Service will be uninterrupted or error-free. We are entitled, without notice and without liability (a) to suspend the Service for repair, maintenance, improvement or other technical reason and (b) to make changes to the Service provided these don’t have a seriously negative affect the Service.

19.2 You acknowledge that technology is not always secure and you accept the risks inherent in use of the Internet or other technology for the purpose of the Service.

20. Ending or suspending this contract

20.1 You may at any time end this contract by closing your account or otherwise following any applicable instructions on our Service. (This doesn’t entitle you to a refund unless you have Consumer “cooling off” rights, explained above.) You may close your account at any time using our self-service online cancellation page at www.childcare.co.uk/cancel. You may at any time end this contract by closing your account or otherwise following any applicable instructions on our Service. (This doesn’t entitle you to a refund unless you have Consumer “cooling off” rights, explained above.)

20.2 We are entitled at any time to end this contract if we terminate our Service as a whole or if in our reasonable opinion it is necessary to do so for security, technical or operational reasons.

20.3 We are entitled to end this contract or suspend part or all of our Service or impose restrictions on our Service if:

a) you break this contract;

b) you are subject to repeated complaints by other Users and/or negative reviews;

c) any fees due to us are unpaid / unjustifiably charged back;

d) we think that it is necessary to protect us or others;

e) we are required to do so by law or appropriate authority; or

f) you or anyone on your behalf acts inappropriately towards our staff.

20.4 If you are a Childcare Provider and we end the contract, we will give you at least 30 days’ notice unless we have a legal or regulatory obligation, or a legal right, to end it earlier, or you have repeatedly broken this contract.

20.5 If we suspend our Service, you remain responsible to pay for our Service during the period of suspension if you were at fault. We are entitled to make resumption of a suspended Service subject to reasonable conditions including payment of a reasonable fee.

20.6 If this contract ends:

a) Your right to use our Service and all licences are terminated.

b) Existing rights and liabilities are unaffected.

c) All clauses in this contract which are stated or intended to continue after termination will continue to apply.

d) You must not attempt to re-register for or continue to use our Service if we have given you notice of termination.

e) After the end of the contract, we may retain access to information provided or generated by Childcare Providers and Parents in order to deal with disputes, enforce our terms and conditions or manage or improve our Service generally. See our Privacy Policy for more information about our retention of personal information.

21. Restrictions on our legal responsibility - very important

21.1 Nothing in this agreement in any way limits or excludes our liability for negligence causing death or personal injury or for fraud or fraudulent misrepresentation or for anything which may not legally be excluded or limited. In this section, any reference to us includes our employees and agents, who have the right to enforce this agreement.

21.2 Very important: If you are a Consumer, we shall not be liable for any loss or damage where:

a) there is no breach of a legal duty owed to you by us or by any of our employees or agents;

b) such loss or damage was not reasonably foreseeable (meaning it was not an obvious consequence of our breach or not contemplated by you and us at the time we entered into this contract);

c) (and to the extent that) such loss or damage is caused by you, for example by not complying with this agreement; or

d) such loss or damage relates to a business of yours.

21.3 Very important: If you are a Consumer, you will be responsible to us for any reasonably foreseeable loss or damage we suffer (including claims made by other people) arising from your breach of this agreement or misuse of our Service.

21.4 The following clauses apply only if you are not a Consumer:

a) If you are or were a subscriber, our liability of any kind (including our own negligence) for any act or omissions or series of connected acts or omissions is limited to the total fees paid by you to us in connection with our Service in the 12 months before the act or omissions complained of.

b) In no event (including our own negligence) will we be liable for any:

  • economic losses (including, without limit, loss of revenues, profits, contracts, business or anticipated savings);
  • loss of goodwill or reputation;
  • special, indirect or consequential losses; or
  • damage to or loss of data

(even if we have been advised of the possibility of such losses).

c) You will indemnify us against all claims and liabilities directly or indirectly related to your use of the Service and/or breach of this agreement.

d) To the extent allowed by law, you and we exclude all terms, whether imposed by statute or by law or otherwise, that are not expressly stated in this agreement.

e) This agreement constitutes the entire agreement between us with respect to its subject matter and supercedes any previous communications or agreements between us. We both acknowledge that there have been no misrepresentations and that neither of us has relied on any pre-contractual statements. Liability for misrepresentation (excluding fraudulent misrepresentation) relating to the terms of this agreement is excluded.

21.5 If you use our App, the following applies where Apple Inc is the Appstore:

a) In the event of any failure of the App to conform to any applicable warranty, you may notify Apple, and Apple will refund the purchase price for the App (if applicable). To the maximum extent permitted by applicable law, Apple will have no other warranty obligation whatsoever with respect to the App, and any other claims, losses, liabilities, damages, costs or expenses attributable to any failure to conform to any warranty will be our sole responsibility subject to these terms and conditions.

b) We, not Apple, are responsible for addressing your claims or the claims of any third party relating to the App or the end-user’s possession and/or use of that App, including, but not limited to: (i) product liability claims; (ii) any claim that the App fails to conform to any applicable legal or regulatory requirement; and (iii) claims arising under consumer protection or similar legislation.

22. Intellectual property rights

22.1 The intellectual property rights in all material used on or in connection with our Service are owned by us or by our partners or other Users. For your personal use only, you may view such material on your device. You must not otherwise use such material including copying, selling or adapting it or taking extracts from it without our specific prior written consent. You must not misrepresent the ownership or source of such material, for example by changing or removing any legal notices or author attributions.

22.2 Just to be clear - you must not collect, scrape, harvest, frame or deep-link to any Content on our Service without our specific prior written consent.

22.3 You must not reverse-engineer or decompile any of our software in any way (except to the extent allowed by applicable law). You must not create or use a modified or derivative version of our software or distribute or sublicense our software to third parties. You must take reasonable steps to ensure that our software is not disclosed to any third party.

22.4 If you upload any Content to our Service (including logos, trade marks and brand names), you retain ownership of the intellectual property rights. You allow us at no cost, and forever, to use and adapt all or part of such material however we wish on our Service and on other peoples’ websites (e.g. job search websites such as Google Jobs). You waive your “moral rights” in relation to such Content to the extent legally allowed. You also allow each User to use your Content in accordance with these terms and conditions.

22.5 In the event of any third party claim that the App or your possession and use of the App infringes that third party’s intellectual property rights, we, not the Appstore, will be solely responsible for the investigation, defence, settlement and discharge of any such intellectual property infringement claim.

23. Privacy

23.1 You acknowledge and agree that we may process your personal information in accordance with the terms of our privacy and cookies policy which is subject to change from time to time.

23.2 You acknowledge that we do not supply Users with access to any personal or other information provided to us or generated by use of our Service other than as explained on our Service. We do not share any such information with anyone else except insofar as this is necessary for the proper functioning of our Service.

24. Events outside our control

24.1 We are not liable for failure to perform or delay in performing any obligation under this agreement if the failure or delay is caused by any circumstances beyond our reasonable control including third party telecommunication failures.

25. Legal compliance

25.1 If you use our App,You promise that (i) you are not located in a country that is subject to a U.S. Government embargo, or that has been designated by the U.S. Government as a “terrorist supporting” country; and (ii) you are not listed on any U.S. Government list of prohibited or restricted parties. (This clause is required by Apple, Inc.)

26. Apple Inc is a “Third Party Beneficiary”

26.1 Where Apple Inc is the Store:  You acknowledge and agree that Apple, and Apple’s subsidiaries, are third party beneficiaries of this agreement, and that Apple will have the right (and will be deemed to have accepted the right) to enforce this agreement against you as a third party beneficiary thereof.

27. Transfer

27.1 We may transfer all or part of our rights or duties under this agreement provided we take reasonable steps to ensure that your rights under this agreement are not prejudiced. As this agreement is personal to you, you may not transfer any of your rights or duties under it without our prior written consent.

28. English law

28.1 This contract is under English law and any disputes will be decided only by the courts of the United Kingdom. You may be entitled to use an EU online dispute resolution service to assist with any contractual dispute you may have with us. This service can be found at http://ec.europa.eu/consumers/odr/. You can contact us at www.childcare.co.uk/contact.

29. General

29.1 We may send all notices under this agreement by email to the most recent email address you have supplied to us (unless otherwise stated in this agreement). You can contact us at www.childcare.co.uk/contact. Headings used in this agreement are for information and not binding. If either of us overlooks any breach of this agreement by the other, it can still be actioned later. If any part of this agreement is ineffective or unenforceable for any reason, the rest of the agreement shall continue to apply. A person who is not a party to this agreement shall have no rights to enforce this agreement except insofar as expressly stated otherwise. The parties are independent contractors and, except as otherwise specifically stated above, nothing in this agreement constitutes any party as agent, employee or representative of the other.

30. Complaints

30.1 If you have any complaints, please contact us via the contact details shown below.

31. Company information

31.1 Company name: Childcare Limited

31.2 Trading name: “Childcare.co.uk”

31.3 Country of incorporation: England and Wales.

31.4 Registered number: 6020111

31.5 Registered office: 1 High Street Mews, Wimbledon Village, London, SW19 7RG

31.6 Contact address: Suite 207, 548-550 Elder House, Elder Gate, Milton Keynes, MK9 1LR

31.7 Other contact information: Website: www.childcare.co.uk/contact

31.8 VAT number: GB 977412196



Version: 3.0



MODEL CANCELLATION FORM

Complete and return this form only if you wish to cancel the contract:

– To Childcare Limited, Suite 207, 548-550 Elder House, Elder Gate, Milton Keynes, MK9 1LR, support@childcare.co.uk:

– I/We [*] hereby give notice that I/We [*] cancel my/our [*] contract of sale of the following goods [*]/ for the supply of the following service [*],

– Ordered on [*]/received on [*],

– Name of consumer(s),

– Address of consumer(s),

– Signature of consumer(s) (only if this form is notified on paper),

– Date

[*] Delete as appropriate