Terms and conditions
Last updated: 17/06/2026
1. Introduction
FAUMA is a platform that enables its users to connect with animal species and real conservation projects by acquiring physical products specially designed to support research, scientific outreach, animal welfare and biodiversity protection initiatives (hereinafter, the "Products").
The acquisition of these Products also grants access, for the period indicated in each case, to digital content related to the selected species or project, including audiovisual, educational, informational and monitoring materials produced by FAUMA and its partner organisations.
Furthermore, by purchasing FAUMA Products, users contribute to the support and visibility of the associated initiatives.
This document (together with all documents referred to herein) sets out the terms governing the use of the FAUMA platform, both through the website (www.fauma.com) and the corresponding mobile application (hereinafter, interchangeably, the "Platform"), as well as the purchase of products through it (the "Terms"), regardless of the application, digital medium, device or technology used to access it.
Please read these Terms, our Privacy Policy and our Cookies Policy (the "Privacy and Cookies Policy") carefully before using the Platform. By using the Platform or placing an order through it, you agree to be bound by these Terms and the Privacy and Cookies Policy. If you do not agree with them, you must refrain from using the Platform.
If you have any questions relating to these Terms or the Privacy and Cookies Policy, you may contact us through the contact channels indicated below.
The contract may be concluded, at the user's choice, in any of the languages in which the Terms are available on the Platform.
2. Our details
The sale of Products through the Platform is carried out under the name FAUMA by Tine Verse, S.L.U., a company incorporated under Spanish law, with registered address at Calle Castanyer, s/n, Oropesa del Mar (Castellón), VAT number B-13684378, and email address info@fauma.com.
Certain content, animal species or conservation projects available on the Platform may be developed in collaboration with foundations, research centres, zoos, aquariums or other organisations dedicated to conservation, research, scientific outreach or animal welfare. The participation of such organisations shall be governed by the agreements entered into between them and FAUMA, and such participation does not establish any contractual relationship between those organisations and the users of the Platform, who shall in all cases contract exclusively with FAUMA.
3. Your data and your visits to the Platform
The information or personal data you provide to us will be processed in accordance with the Privacy and Cookies Policy.
By using the Platform, registering as a user or placing any order through it, you warrant that the information and data provided are accurate, complete and truthful, and you undertake to keep them duly updated.
By using the Platform, you also consent to the processing of your personal data as described in the Privacy and Cookies Policy and declare that you have read and understood the information relating to such processing.
FAUMA may use the data provided by users to manage orders placed, enable access to the digital content associated with Products purchased, provide customer support, manage incidents and carry out any other actions necessary for the proper functioning of the Platform, all in accordance with applicable data protection law.
4. Use of the Platform
By using the Platform and placing orders through it, you undertake to:
- Use the Platform solely for making enquiries, registering as a user, accessing content associated with Products purchased and placing legally valid orders.
- Not place any false, fraudulent or unlawful order. If an order of this nature is reasonably suspected, we are entitled to cancel it and notify the competent authorities.
- Keep your user account access credentials confidential and refrain from sharing, transferring, selling, publishing or making them available to third parties.
- Not use the Platform, its digital content, available features or any material accessible through it in a manner contrary to law, good faith, public order or these Terms.
- Not copy, distribute, publicly communicate, make available to third parties, commercialise, transform or exploit the digital content accessible through the Platform beyond the uses expressly authorised by FAUMA.
- Provide your email address, postal address and/or other contact details accurately and truthfully. You also consent to us using this information to contact you when necessary for the management of your order, user account or access to the digital content associated with Products purchased (see our Privacy and Cookies Policy).
If you do not provide us with all the information we require, we will be unable to process your order or properly enable access to the corresponding digital content.
Access to the Platform and the Digital Content associated with each Product is personal and non-transferable. Accordingly, the user may not grant third parties access to their account or use any mechanism intended to enable simultaneous or shared access by multiple persons.
We reserve the right to prevent your access to the Platform, suspend or cancel your user account and block access to certain content where your conduct constitutes a breach of these Terms, applicable law or the rights of third parties.
By placing an order through the Platform, you declare that you are over 18 years of age and have full legal capacity to enter into contracts.
5. Service availability
Products offered through the Platform are available for delivery within the European Union. However, the delivery, collection and shipping options available may vary depending on the destination country, the characteristics of the Product purchased and the logistical circumstances in place at any given time.
Products may also be collected from establishments, partner centres or collection points designated by FAUMA.
Before completing an order, the user may consult the delivery or collection options available for the selected territory, as well as the applicable costs and timeframes.
FAUMA reserves the right to temporarily restrict or exclude delivery of certain Products to specific territories where logistical, regulatory, technical or operational circumstances justify doing so.
6. How FAUMA works
6.1. How the Platform works
FAUMA allows its users to turn their interest into a direct way of contributing to the outreach, research, conservation of biodiversity and animal welfare. The general operation of the Platform is as follows:
- The user selects an animal species or conservation project available on the Platform.
- They choose the level of participation or involvement available for that species or project (for example, Friend, Brother or Hero, or any other designations that may be established from time to time).
- They select one or more Products associated with that level.
- They complete the purchase following the procedure set out on the Platform.
- They receive the Product by home delivery or collection from a designated point, according to the selected option.
- Once payment for the order has been correctly verified, access to the digital content associated with the Product purchased will be automatically enabled for the period indicated in each case (the "Digital Content").
The specific characteristics of each species, project, Product, level of participation or associated Digital Content may vary from time to time and will be described in the relevant information sheet available on the Platform.
6.2. Access to Digital Content
The acquisition of certain Products will grant access to Digital Content associated with a specific species or project.
Unless expressly stated otherwise in the Product sheet, access to such Digital Content will be automatically enabled in the user account used to make the purchase once payment has been correctly verified.
Access is personal and non-transferable and will remain linked to the user account from which the Product was purchased.
Unless a different period is expressly stated in the Product sheet, the acquisition of Products associated with a species or project will grant access to the corresponding Digital Content for a period of twelve (12) months from the activation of such access.
Certain conservation or research projects may have a shorter duration. In such cases, this will be expressly indicated prior to purchase.
6.3. Availability of species and projects
The Digital Content associated with a specific species or project may vary over time depending on biological, veterinary, technical, scientific, operational or conservation circumstances.
If the generation or availability of content relating to a particular species or project ceases to be possible or becomes significantly limited, FAUMA may replace such content with content related to equivalent species, individuals or conservation projects, seeking to maintain a similar theme and educational value.
Such substitution will not entitle the user to cancellation, refund, compensation or reduction of the price paid, provided that the user continues to have access to equivalent Digital Content during the contracted access period.
6.4. Allocation of funds
FAUMA will allocate a percentage of the revenue obtained to support conservation, research, animal welfare, biodiversity protection and scientific outreach projects carried out by partner organisations.
The applicable percentage and the beneficiary project may vary depending on the species, Product or project selected.
The acquisition of Products through the Platform constitutes a sale of goods and services between the user and FAUMA. Amounts paid by users do not constitute donations, contributions or direct payments to partner organisations or to the conservation, research or animal welfare projects linked to the Products purchased. Accordingly, the purchase of Products through the Platform does not entitle users to obtain donation certificates, tax benefits, tax deductions or any other tax incentives provided for contributions made to organisations eligible for patronage tax treatment.
Without prejudice to the foregoing, FAUMA may inform users about the projects supported, the initiatives funded or the impact generated through the revenue obtained from the sale of its Products.
7. Nature of the Digital Content
The digital content offered through FAUMA is educational, informational and environmental awareness-raising in nature.
FAUMA does not guarantee the generation of a specific volume of content, nor the occurrence of particular events related to a species or project, as these depend on biological, veterinary, scientific and operational circumstances beyond its control.
Available content may be updated, modified, expanded or replaced during the period of access granted to the user.
The user's subjective lack of interest in the published content, or their personal preferences regarding the frequency, format or subject matter of such content, will not give rise to any right to a refund, financial compensation or reduction of the price paid.
Access to digital content constitutes an ancillary service linked to the purchase of Products sold through the Platform and does not constitute an independent subscription or a standalone service contracted separately by the user.
8. Orders and product availability
8.1. Purchase procedure
To place an order, you must follow the purchase procedure set out on the Platform, select the desired Products and complete the corresponding payment process.
Once the process is complete, the user will receive an email acknowledging receipt of their order (the "Order Confirmation"). FAUMA will subsequently send a further communication informing about the preparation, dispatch or availability for collection of the Products purchased (the "Dispatch Confirmation" or the "Collection Confirmation", as applicable).
The order will be subject to correct receipt of payment and availability of the selected Products.
The acquisition of certain Products will grant access to digital content associated with a specific species or project. Unless expressly stated otherwise, such access will be automatically enabled once the purchase process is complete and payment has been verified.
8.2. Correcting errors
If you notice that an error was made when entering your personal details during the registration or purchase process, you may amend them by contacting customer support through the channels available on the Platform.
In any event, the Platform incorporates validation and confirmation steps designed to detect errors before the order is finalised. In particular, the user may review and amend the selected Products, delivery address, collection method, billing details and other relevant elements before making payment.
If the user detects an error after the purchase process is complete, they must notify FAUMA as soon as reasonably possible so that it can be corrected.
8.3. Product availability
All orders are subject to Product availability. If supply difficulties, inventory errors or out-of-stock situations arise in relation to a requested Product, FAUMA will inform the user as soon as reasonably possible and may, depending on the circumstances, offer a substitute Product of equivalent characteristics, an extended delivery timeframe or a refund of the amounts paid for the affected Product.
The availability of certain Products may be affected by manufacturing, logistics or supply circumstances.
The supervening impossibility of supplying a particular Product will not in itself affect access to Digital Content already enabled for the user where FAUMA proceeds to substitute or replace the affected Product. If the solution adopted consists of a full refund of the price paid for the order, FAUMA may cancel access to the Digital Content associated with that Product.
9. Delivery and collection of Products
9.1. Delivery options
Before finalising the order, the user must select one of the delivery or collection options available for the Product purchased.
FAUMA may offer, among others, the following options:
- Home delivery within the EU.
- Collection from establishments, partner centres or collection points designated by FAUMA.
The availability of each option may vary depending on the Product purchased, the user's location or the logistical and operational circumstances in place at any given time.
9.2. Delivery timeframes
Unless expressly stated otherwise during the purchase process, Products will be delivered or made available to the user without undue delay and, in any event, within a maximum period of thirty (30) calendar days from the Order Confirmation.
If FAUMA anticipates that it will be unable to meet the initially indicated timeframe, it will inform the user as soon as possible, who may choose to maintain the order with a new estimated delivery date or cancel the purchase with a full refund of the amounts paid.
9.3. Collection from establishments and partner points
Where the user selects the option of collection from an establishment or partner point, they will receive a communication indicating that the Product is available for collection.
Collection may be carried out by presenting the QR code, digital proof of purchase or any other identification mechanism established by FAUMA from time to time.
At certain establishments or partner centres, the user may complete the purchase directly through the Platform and collect the Product almost immediately once the order has been confirmed and payment verified.
The availability of this option may vary depending on the establishment, the selected Product and the availability of stock at any given time.
9.4. Failure to deliver or collect
If delivery proves impossible or the user fails to collect the Product made available to them, FAUMA will contact them using the details provided during the purchase process in order to agree on a reasonable solution.
If thirty (30) days have elapsed from the date on which the Product was made available to the user and they have not collected or received it without justified cause, FAUMA may consider the order abandoned and cancel the sale, refunding the user the amounts paid after deducting, where applicable, any transport, storage, return or handling costs actually incurred — unless the user has already accessed the Digital Content, in which case no refund will apply.
9.5. Transfer of risk and title
Risk in the Products will transfer to the user from the moment of physical delivery or when made available for collection, as applicable.
Title to the Products will transfer to the user once FAUMA has received full payment of all amounts due in relation to them.
10. Price, payment and invoicing
10.1. Price
The prices of Products shown on the Platform are expressed in euros (€) and include, unless expressly stated otherwise, the applicable Value Added Tax (VAT) in force at any given time.
Unless expressly stated otherwise, the price of each Product also includes access to the associated Digital Content on the terms set out in these Terms.
Shipping costs, where applicable, will be displayed separately during the purchase process before the order is finally confirmed.
FAUMA may modify the prices of Products at any time. However, such changes will not affect orders for which an Order Confirmation has already been sent.
10.2. Payment procedure
Once you have selected the Products you wish to purchase, they will be added to your shopping basket and you may complete the contracting process by following the instructions shown on the Platform.
Before making payment, the user may review and amend the selected Products, quantities, delivery or collection method, billing details and any other relevant aspects of the order.
Placing the order by selecting the "Authorise Payment" option, or any equivalent expression used on the Platform, will constitute the final confirmation of the purchase and the corresponding payment obligation.
10.3. Payment methods
The Platform will accept the payment methods indicated from time to time during the purchase process, including, among others: bank cards, Apple Pay, Google Pay or other available electronic payment systems.
Certain payment methods may be managed by external providers specialising in payment services. The use of such methods may be subject to the additional terms and policies established by the corresponding providers.
The availability of each payment method may vary depending on the device used, the user's geographical location or the conditions set by the relevant payment service providers.
By making payment, the user declares that they are the legitimate holder of the payment method used or that they have sufficient authorisation to use it.
10.4. Payment security
In order to ensure the security of transactions, payment data will be processed using secure encryption systems and may be subject to verification, authentication or authorisation processes by financial institutions, payment service providers or issuers of the corresponding payment instruments.
If the issuing institution or payment service provider does not authorise the transaction, FAUMA will be unable to process the order and will bear no liability for any delays or failure to execute arising from such non-authorisation.
10.5. Invoicing
The Order Confirmation sent by FAUMA will constitute proof of purchase and, where legally required, a simplified invoice for the purposes of applicable law.
If the user requires a full invoice, they may request its issuance at any time through the customer service channels available from FAUMA, providing the necessary tax details for its preparation.
Full invoices may be issued in electronic format and will be available in the manner indicated during the purchase process or through the user account where that functionality is available. The user may also request that the invoice be issued in paper format.
11. Returns policy
11.1. Legal right of withdrawal
If you are contracting as a consumer or user, you have the right to withdraw from this contract within 14 calendar days without giving any reason.
The withdrawal period will expire 14 calendar days after the day on which you, or a third party indicated by you other than the carrier, physically takes possession of the Product.
To exercise the right of withdrawal, you must notify FAUMA of your decision to withdraw from the contract by means of an unequivocal statement (for example, a letter sent by post or email). You may use the model withdrawal form provided as an Annex to these Terms, although its use is not mandatory.
To meet the withdrawal deadline, it is sufficient for you to send your communication exercising this right before the relevant period expires.
11.2. Supply of Digital Content
Certain Products sold through the Platform come with immediate access to Digital Content that is automatically enabled once payment for the order has been verified.
By completing the purchase, the user expressly requests the immediate supply of such Digital Content and acknowledges that it will begin to be provided before the end of the legal withdrawal period.
To the extent permitted by applicable law, the effective access to Digital Content may affect the exercise of the right of withdrawal in respect of such content or of those elements that are inseparable from the contracted service.
11.3. Exclusions from the right of withdrawal
Your right to withdraw from the contract applies exclusively to Products that are returned in the same condition as when you received them. No refund will be made if the Product has been used beyond mere opening, if the product is not in the same condition as when delivered, or if it has been damaged.
11.4. Returns procedure
Products may be returned using the methods made available by FAUMA from time to time, including delivery to establishments or partner points, return through authorised logistics points, or collection by a carrier.
Unless you return the goods through an establishment or partner point, you must bear the direct cost of returning the goods.
The user must return the Product without undue delay and, in any event, within fourteen (14) calendar days of communicating their decision to withdraw.
Products must be returned in adequate condition, accompanied by all items, accessories, instructions or packaging supplied with them, without prejudice to any handling necessary to check their nature, characteristics and functioning.
FAUMA may withhold the refund until it has received the Product or until the user provides sufficient evidence of its return, whichever occurs first.
11.5. Size exchange
Size exchanges apply only to clothing items.
They do not apply to pins, 3D figures, collectible items, personalised products or any other Products for which size is not applicable.
The specific conditions of the size exchange service will be indicated on the Platform from time to time.
12. Defective products
If the user considers that the Product received has manufacturing defects, production errors, damage suffered during transport or any other lack of conformity with what was contracted, they must notify FAUMA as soon as reasonably possible through the customer service channels available on the Platform.
For this purpose, the user must provide a description of the incident and, where reasonably possible, photographs or other evidence that help identify the problem.
FAUMA may request the return of the affected Product or, where sufficient to verify the incident, require additional information before reaching a decision.
Once the claim and, where applicable, the returned Product have been examined, FAUMA will inform the user within a reasonable period whether repair, replacement, restitution, price reduction or refund of the amount paid is appropriate, in accordance with applicable law.
Where a lack of conformity attributable to FAUMA is confirmed, FAUMA will bear the reasonable transport and return costs necessary for the management of the incident.
These provisions are without prejudice to the rights to which the user is entitled under the consumer and user protection law applicable from time to time.
13. Warranties
If you are contracting as a consumer and user, you are entitled to remedies, free of charge, in the event of a lack of conformity of the Products supplied through the Platform.
FAUMA will be liable for any lack of conformity that becomes apparent in the Products within the legally established periods and in accordance with the consumer and user protection law applicable at any given time.
Products will be deemed to conform to the contract when they:
- conform to the description, type, quantity and quality indicated on the Platform;
- are fit for the purposes for which products of the same type are ordinarily used;
- have the quality, functionality and performance usual for products of the same nature that can reasonably be expected.
With regard to the Digital Content associated with the Products, FAUMA warrants that it will be accessible and usable in a reasonably adequate manner during the corresponding access period, in accordance with the characteristics described on the Platform.
However, given the nature of the conservation, research and outreach projects linked to FAUMA, no guarantee is given as to the generation of a specific volume of content, the publication of content at any particular frequency, or the content remaining unchanged throughout the entire access period.
Furthermore, the content, features and materials available may be updated, expanded, modified or replaced during the term of access, in accordance with the provisions of these Terms.
Products manufactured using artisan techniques, 3D printing, on-demand production or natural materials may present slight variations in colour, texture, finish, dimensions or details compared to the images shown on the Platform. Such variations, provided they do not substantially affect the functionality or overall appearance of the Product, shall not constitute a defect, flaw or lack of conformity.
This commercial warranty is without prejudice to any rights to which the user is entitled under applicable law.
14. Liability
The user is responsible for keeping the access credentials associated with their user account safe and secure.
FAUMA will not be liable for any unauthorised access resulting from the loss, transfer, misuse or failure to exercise due care in keeping such credentials, unless such circumstances are directly attributable to FAUMA.
FAUMA will take reasonable measures to ensure the proper functioning of the Platform and access to the Digital Content associated with the Products. However, it does not guarantee uninterrupted availability of the Platform or the complete absence of technical incidents, temporary interruptions, maintenance tasks, transmission errors or circumstances beyond its control.
Furthermore, FAUMA will not be liable for the unavailability or modification of certain content where this is caused by biological, veterinary, scientific, technical, operational or conservation circumstances, or by the conclusion of projects or collaborations with third parties.
Unless otherwise required by mandatory law, and without prejudice to the rights of consumers and users, FAUMA's total liability arising from any claim relating to a specific Product or order will be limited to the amount actually paid for that Product or order.
15. Industrial and intellectual property
All industrial and intellectual property rights in the Platform, the Products, the Digital Content, audiovisual materials, photographs, videos, texts, designs, three-dimensional models, illustrations, trade marks, trade names, logos, software, databases and any other elements accessible through the Platform belong to FAUMA or to third parties who have lawfully authorised their use.
Access to the Platform or the purchase of Products does not in any case imply the transfer, assignment, licence or waiver of such rights beyond the limited right of personal use provided for in these Terms.
The user may use the Digital Content exclusively for personal, private and non-commercial purposes. Any reproduction, distribution, public communication, making available to third parties, transformation, commercial exploitation or any other use other than that expressly authorised by FAUMA is strictly prohibited.
The user may use the Platform to the extent necessary to place orders, access the Digital Content associated with Products purchased and retain information relating to their purchases.
FAUMA reserves the right to take such technical and legal measures as may be necessary to protect its industrial and intellectual property rights and those of its collaborators.
16. Platform security
The user undertakes to use the Platform diligently, responsibly and in accordance with applicable law.
In particular, the user will refrain from introducing viruses, malware, trojans, worms or any other technologically harmful programme, code or material, and from carrying out actions intended to alter, damage, overload, interrupt or compromise the operation of the Platform or the systems associated with it.
It is also prohibited to attempt to gain unauthorised access to user accounts, servers, databases, computer systems or any technology resources linked to the Platform.
Failure to comply with the provisions of this clause may result in the immediate suspension or cancellation of the user's account, without prejudice to any legal action available to FAUMA.
FAUMA will implement reasonable security measures to protect the Platform and the information managed through it, but cannot guarantee the complete absence of incidents, vulnerabilities or unlawful access resulting from the actions of third parties beyond its control.
17. Links to third-party sites
The Platform may contain links, access points or references to websites, applications, content or services owned by third parties.
Such links are provided solely for information, educational or convenience purposes for the user and do not imply any relationship between FAUMA and the owners of such resources, unless expressly stated otherwise.
FAUMA does not control and accepts no liability for the content, availability, accuracy, privacy policies, terms of use or practices of third-party websites or services accessible through such links.
The use of such external resources is entirely at the user's own risk.
18. Miscellaneous
18.1. Electronic communications
Applicable law requires that some of the information or communications we send you be in writing.
By using the Platform, you accept that most communications with FAUMA will take place by electronic means. For these purposes, we may contact you by email, through notifications within the Platform or by posting notices on it.
For contractual purposes, you expressly consent to the use of such electronic means and acknowledge that all communications, notices, information or documentation sent in this way meet the legal requirements for written communication.
This is without prejudice to the rights recognised to consumers and users under applicable law.
18.2. Notices
Notices or communications addressed to FAUMA must be sent through the contact channels available on the Platform.
Unless expressly agreed otherwise, FAUMA may address its communications to the user using the email address, telephone number or postal address provided during the registration or purchase process.
Electronic communications will be deemed to have been made at the time of sending, unless proven otherwise.
18.3. Assignment of rights and obligations
The contract will be binding on the parties and their respective successors and assignees.
The user may not assign, transfer or convey the rights or obligations arising from these Terms without the prior written consent of FAUMA.
FAUMA may assign, transfer, subcontract or convey all or part of its rights and obligations arising from these Terms to any company within its corporate group or to third parties that succeed, in whole or in part, to the business carried out through the Platform, provided that this does not result in any reduction of the rights legally recognised to the user.
18.4. Force majeure
FAUMA will not be liable for any delays or failures arising from events beyond its reasonable control, including, among others, natural disasters, armed conflicts, acts of authority, pandemics, widespread telecommunications service outages, essential supply failures, labour disputes or any other circumstances of a similar nature.
While the force majeure situation persists, the affected obligations will be suspended for the period strictly necessary to overcome its effects.
18.5. Waiver
FAUMA's failure to exercise any right or power recognised under these Terms will not constitute a waiver of such rights or prevent their subsequent exercise.
Any waiver must be express and in writing.
18.6. Severability
If any provision of these Terms is declared null, invalid or unenforceable by a final decision of a competent authority, that provision will be deemed not to form part of the Terms, and the remaining provisions will continue in full force and effect.
18.7. Entire agreement
These Terms, together with the Privacy and Cookies Policy and any other documents expressly incorporated by reference, constitute the entire agreement between FAUMA and the user in relation to access to and use of the Platform and the purchase of Products through it.
18.8. Amendments to the Terms
FAUMA may amend these Terms at any time to reflect regulatory, technical, operational or business changes.
Amendments will not have retroactive effect and will apply from the date of their publication on the Platform.
18.9. Governing law and jurisdiction
These Terms will be governed by and construed in accordance with Spanish law.
Any dispute that may arise in connection with the Platform or the purchase of Products through it will be submitted to the courts and tribunals with jurisdiction under applicable law.
If the user is a consumer, nothing in this clause will limit the rights recognised to them under applicable law.
18.10. Contact
For any enquiry relating to the Platform, the Products, the Digital Content or these Terms, users may contact FAUMA through the following customer service channels:
Email: info@fauma.com
Postal address: Calle Castanyer, s/n — 12594 Oropesa del Mar (Castellón)
Thank you for joining our community and contributing to the protection of animals. Your participation makes a difference.
Annex · Model withdrawal form
(Complete and return this form only if you wish to withdraw from the contract.)
To the attention of Tine Verse, S.L.U., trading as FAUMA, with registered address at Calle Castanyer, s/n — 12594 Oropesa del Mar (Castellón) and email address info@fauma.com.
I hereby give notice that I withdraw from my contract of sale of the following goods:
- Ordered on / received on (*): ____________________
- Name of consumer: ____________________
- Address of consumer: ____________________
- Signature of consumer (only if this form is submitted on paper): ____________________
- Date: ____________________
(*) Delete as appropriate.
